Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 258
Filtrar
1.
Int J Cancer ; 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31584196

RESUMO

Human papillomavirus (HPV) infection and tobacco smoking are well-known risk factors for head and neck cancers (HNC). Although an effect modification between oral HPV infection and tobacco smoking may exist, evidence is lacking on how they interact temporally. We investigated the latency and life course effects of tobacco smoking on risk of HNC among HPV-positive (HPV+ve ) and negative (HPV-ve ) individuals. We used data from 631 ever-smoker participants of a hospital-based case-control study conducted in four major hospitals in Montréal, Canada. Cases (n = 320), incident, histologically confirmed, primary squamous cell carcinomas, were frequency-matched to controls (n = 311) by age and sex. Sociodemographic and behavioral factors (e.g., tobacco and alcohol use and sexual history) were collected using a structured interview applying a life grid technique. Oral exfoliated cells were used for HPV DNA detection and genotyping. Latency effects were estimated flexibly using a Bayesian relevant exposure model and further extended with a life course approach. Retrospective smoking trajectories for HPV+ve cases and controls had similar shapes. Exposure to tobacco smoking even 40 years before diagnosis was associated with an increased HNC risk among both HPV+ve and HPV-ve participants. The effect of smoking before the start of sexual activity compared to afterwards was higher among HPV+ve individuals. This pattern of association was less profound among HPV-ve participants. Temporal interactions may exists between oral HPV infection and life course smoking trajectories in relation to HNC risk.

2.
Stat Med ; 38(23): 4566-4573, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31297825

RESUMO

Many sample size criteria exist. These include power calculations and methods based on confidence interval widths from a frequentist viewpoint, and Bayesian methods based on credible interval widths or decision theory. Bayesian methods account for the inherent uncertainty of inputs to sample size calculations through the use of prior information rather than the point estimates typically used by frequentist methods. However, the choice of prior density can be problematic because there will almost always be different appreciations of the past evidence. Such differences can be accommodated a priori by robust methods for Bayesian design, for example, using mixtures or ϵ-contaminated priors. This would then ensure that the prior class includes divergent opinions. However, one may prefer to report several posterior densities arising from a "community of priors," which cover the range of plausible prior densities, rather than forming a single class of priors. To date, however, there are no corresponding sample size methods that specifically account for a community of prior densities in the sense of ensuring a large-enough sample size for the data to sufficiently overwhelm the priors to ensure consensus across widely divergent prior views. In this paper, we develop methods that account for the variability in prior opinions by providing the sample size required to induce posterior agreement to a prespecified degree. Prototypic examples to one- and two-sample binomial outcomes are included. We compare sample sizes from criteria that consider a family of priors to those that would result from previous interval-based Bayesian criteria.

3.
Epidemiology ; 30(5): 659-668, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31205289

RESUMO

BACKGROUND: Soil-transmitted helminth infections have been found to be associated with child development. The objective was to investigate hemoglobin levels and malnutrition as mediators of the association between Ascaris infection and intelligence quotient (IQ) scores in children. METHODS: We conducted a longitudinal cohort study in Iquitos, Peru, between September 2011 and July 2016. A total of 1760 children were recruited at 1 year of age and followed up annually to 5 years. We measured Ascaris infection and malnutrition at each study visit, and hemoglobin levels were measured as of age 3. The exposure was defined as the number of detected Ascaris infections between age 1 and 5. We measured IQ scores at age 5 and used Bayesian models to correct exposure misclassification. RESULTS: We included a sample of 781 children in the analysis. In results adjusted for Ascaris misclassification, mean hemoglobin levels mediated the association between Ascaris infection and IQ scores. The natural direct effects (not mediated by hemoglobin) (95% CrI) and natural indirect effects (mediated by hemoglobin) (95% CrI) were compared with no or one infection: -0.9 (-4.6, 2.8) and -4.3 (-6.9, -1.6) for the effect of two infections; -1.4 (-3.8, 1.0) and -1.2 (-2.0, -0.4) for three infections; and -0.4 (-3.2, 2.4) and -2.7 (-4.3, -1.0) for four or five infections. CONCLUSION: Our results are consistent with the hypothesis that hemoglobin levels mediate the association between Ascaris infection and IQ scores. Additional research investigating the effect of including iron supplements in STH control programs is warranted.

4.
BMC Infect Dis ; 19(1): 423, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092207

RESUMO

BACKGROUND: Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS: We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS: The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS: BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Pneumopatias/diagnóstico , Adulto , Idoso , Antígenos de Bactérias/urina , Teorema de Bayes , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Feminino , Humanos , Pneumopatias/epidemiologia , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/microbiologia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Tailândia/epidemiologia
5.
Am J Health Promot ; 33(6): 850-858, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30665309

RESUMO

PURPOSE: To evaluate the results of a workplace wellness program that incorporates gamification principles. DESIGN: In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years. SETTING AND PARTICIPANTS: All permanent employees (n = 775) of a national company located in Canada were eligible to participate. INTERVENTION: The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors. MEASURES AND ANALYSIS: The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures. RESULTS: Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (-1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (-0.14), glycated haemoglobin (HbA1c; -0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (-17%), insomnia severity index (-16%), general fatigue (-10%), and reductions in the cardiovascular age gap (-0.3 years). Greater benefits occurred among employees at higher risk. CONCLUSIONS: Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.

7.
Ann Work Expo Health ; 63(3): 267-279, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30551169

RESUMO

INTRODUCTION: Interpretation of exposure measurements has evolved into a framework based on the lognormal distribution. Most available practical tools are based on traditional frequentist statistical procedures that do not satisfactorily account for censored data and are not amenable to simple probabilistic risk statements. Bayesian methods offer promising solutions to these challenges. Such methods have been proposed in the literature but are not widely and freely available to practitioners. METHODS: A set of computer applications were developed aimed at answering typical inferential questions that are important to occupational health practitioners: Is a group of workers compliant with an occupational exposure limit? Are some individuals within this group likely to experience substantially higher exposure than its average member? How does an intervention influence the distribution of exposures? These questions were addressed using Bayesian models, simultaneously accounting for left, right, and interval-censored data with multiple censoring points. The models are estimated using the JAGS Gibbs sampler called through the R statistical package. RESULTS: The Expostats toolkit is freely available from www.expostats.ca as four tools accessible through a Web application, an offline standalone application or algorithms. The tools include a variety of calculations and graphical outputs useful according to current practices in analysis and interpretation of exposure measurements collected by occupational hygienists. Tool1 and its simplified version Tool1 Express focus on inferences from data from a similarly exposed group. Tool2 evaluates within- and between-worker components of variability, as well as the probability that an individual worker might be overexposed. Tool3 compares exposure data across groups, e.g. evaluates the effect of an intervention. Uncertainty management includes the calculation of credible intervals and produces probabilistic statements about the exposure metrics (e.g. probability that over 5% of exposures are above a limit). DISCUSSION: Expostats is the first freely available toolkit that leverages the flexibility of Bayesian analysis to perform an extensive list of calculations recommended in several international guidelines on the practice of occupational hygiene.

8.
J Med Internet Res ; 20(11): e10258, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30465709

RESUMO

BACKGROUND: Although HIV self-testing strategies have been recommended by the World Health Organization, HIV self-tests are not yet approved in Canada. Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing. We developed an innovative, multilingual software app called HIVSmart! to plug these gaps. OBJECTIVE: This study aimed to test our app-optimized oral HIV self-testing strategy for feasibility in men who have sex with men (MSM) who presented to test at a large sexual health clinic (Clinique Médicale L'Actuel) in Montreal. METHODS: Between July 2016 and February 2017, we offered a strategy consisting of the OraQuick In-Home HIV Test (an investigational device) and a tablet installed with the HIVSmart! app to study participants, who presented at a private office in the clinic, mimicking an unsupervised home environment. We evaluated the strategy for its feasibility, acceptability, and preference. Using the HIVSmart! app, participants were guided through the self-testing process. We determined feasibility with a metric defined as the completion rate, which consisted of the following 3 steps: (1) self-test conduct; (2) self-test interpretation; and (3) linkages to care. Participants independently performed, interpreted, recorded their self-test and result, engaged in pre- and posttest counseling, and sought linkages to care. Laboratory tests (p24, Western Blot, and RNA), as per country algorithms, were expedited, and linkages based on the rapid test status were arranged. RESULTS: Mean age of the 451 participants enrolled was 34 (range, 18-73) years. Of all participants, 97.1% (438/451) completed and submitted the survey through the HIVSmart! app. In total, 84.7% (371/438) of the participants were well educated (beyond high school) and 52.5% (230/438) had been tested within the past 6 months. Of the 451, 11.5% (52/451) were on pre-exposure prophylaxis. Feasibility (completion rate), an average proportion of the 3 steps, was computed to be 96.6% (419/451). The acceptability of the strategy was high at 98.5% (451/458). A majority of the participants (448/451, 99.3%) were found to be self-tested and lab-confirmed negative and were counseled after self- and rapid tests. In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. Furthermore, 98.8% (417/422) of the participants found the app to be useful and 94.0% (424/451) were willing to recommend it to a friend or partner. CONCLUSIONS: The HIVSmart! app-optimized strategy was feasible, accepted, and preferred by an educated, urban MSM population of Montreal. With the app, participants were able to perform, interpret, store results, and get rapidly linked to care. The HIVSmart!-optimized, self-testing strategy could be adapted and contextualized to many at-risk populations within Canada and worldwide, thereby maximizing its public health impact.


Assuntos
Infecções por HIV/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos Transversais , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Aplicativos Móveis , Fatores de Risco , Adulto Jovem
9.
Int J Epidemiol ; 47(4): 1180-1194, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30010794

RESUMO

Background: Limited research has documented an association between soil-transmitted helminth (STH) infections and child development. This has recently been identified as an important knowledge gap. Methods: A longitudinal cohort study was conducted in Iquitos, Peru, between September 2011 and July 2016. A cohort of 880 children, recruited at 1 year of age, was followed up to 5 years. STH infection was measured annually and child development was measured with the Wechsler Preschool and Primary Scale of Intelligence III (WPPSI-III) at 5 years. Linear-regression models were used to investigate the effect of the number of detected STH infections between 1 and 5 years of age on WPPSI-III scores at 5 years of age. Bayesian latent class analysis was used to adjust for exposure misclassification. Results: A total of 781 (88.8%) children were included in the analysis. In multivariable analysis, adjusted for STH misclassification, increasing numbers of Ascaris, Trichuris, hookworm and any STH infections were associated with lower WPPSI-III scores. Among the largest observed effects were those for the effect of Ascaris infection on verbal IQ scores [difference in IQ (95% CrI) for two, three, and four or five detected infections compared with zero or one infection: -8.27 (-13.85, -3.10), -6.69 (-12.05, -2.05) and -5.06 (-10.75, 0.05), respectively]. Misclassification of STH infection generally led to a bias towards the null. Conclusions: These results document an association between STH infection and child development. The results highlight the importance of adjusting for STH misclassification; however, future research is needed to accurately determine the sensitivity of STH diagnostic techniques. STH control in preschool children may contribute to lowering the disease burden associated with poor child development.


Assuntos
Desenvolvimento Infantil , Helmintíase/epidemiologia , Solo/parasitologia , Animais , Teorema de Bayes , Pré-Escolar , Feminino , Helmintos , Humanos , Lactente , Modelos Lineares , Estudos Longitudinais , Masculino , Análise Multivariada , Peru/epidemiologia
10.
PLoS Negl Trop Dis ; 12(7): e0006688, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30052640

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) infection leads to malnutrition and anemia, and has been linked to impaired child development. Previous research on this topic is limited and mostly conducted in school-age children. The goal of this study was to determine the effect of the number of detected STH infections between one and two years of age on subsequent cognitive and verbal abilities, in a cohort of preschool children. METHODOLOGY/PRINCIPAL FINDINGS: A longitudinal cohort study was conducted in 880 children in Iquitos, Peru between September 2011 and July 2016. Children were recruited at one year of age and followed up at 18 months and then annually between two and five years of age. STH infection was measured with the Kato-Katz technique or the direct smear technique. Child development was measured with the Bayley Scales of Infant and Toddler Development-III at the one to three-year visits and with the Wechsler Preschool and Primary Scale of Intelligence-III at the four and five-year visits. Hierarchical multivariable linear regression models were used to account for the repeated outcome measures for each child and Bayesian latent class analysis was used to adjust for STH misclassification. Children found infected with any STH infection between one and two years of age had lower cognitive scores between two and five years of age (between group score differences (95% credible intervals) for infected once, and infected two or three times, compared to never infected: -4.31 (-10.64, -0.14) and -3.70 (-10.11, -0.11), respectively). Similar results were found for Ascaris infection and for verbal scores. CONCLUSIONS/SIGNIFICANCE: An association was found between having been infected with Ascaris or any STH between one and two years of age and lower cognitive and verbal abilities later in childhood. These results suggest that targeting children for STH control as of one year of age is particularly important.


Assuntos
Cognição , Helmintíase/parasitologia , Helmintíase/psicologia , Helmintos/fisiologia , Solo/parasitologia , Aprendizagem Verbal , Animais , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Helmintos/genética , Helmintos/isolamento & purificação , Humanos , Lactente , Estudos Longitudinais , Masculino , Peru , Fala
11.
Int J Epidemiol ; 47(5): 1623-1635, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912384

RESUMO

Background: Different hypotheses have been proposed in life course epidemiology on how a time-varying exposure can affect health or disease later in life. Researchers are often interested in investigating the probability of these hypotheses based on observed life course data. However, current techniques based on model/variable selection do not provide a direct estimate of this probability. We propose an alternative technique for a continuous exposure, using a Bayesian approach that has specific advantages, to investigate which life course hypotheses are supported by the observed data. Methods: We demonstrate the technique, the relevant life course exposure model (RLM), using simulations. We also analyse data from a case-control study on risk factors of oral cancer, with repeated measurements of betel quid chewing across life. We investigate the relative importance of chewing one quid of betel per day, at three life periods: ≤20 years, 21-40 years and above 40 years of age, on the risk of developing oral cancer. Results: RLM was able to correctly identify the life course hypothesis under which the data were simulated. Results from the case-control study showed that there was 74.3% probability that betel quid exposure earlier in life, compared with later, results in higher odds of developing oral cancer later in life. Conclusions: RLM is a useful option to identify the life course hypothesis supported by the observed data prior to the estimation of a causal effect.


Assuntos
Teorema de Bayes , Modelos Biológicos , Modelos Estatísticos , Neoplasias Bucais/epidemiologia , Adulto , Distribuição por Idade , Areca/efeitos adversos , Estudos de Casos e Controles , Causalidade , Feminino , Humanos , Índia/epidemiologia , Masculino , Neoplasias Bucais/etiologia , Fatores de Risco , Adulto Jovem
12.
J Occup Environ Med ; 60(3): 211-216, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29200188

RESUMO

OBJECTIVE: The aim of this study was to evaluate the impact of an employee wellness program in Canada. METHODS: A comprehensive program including web-based lifestyle challenges was evaluated with annual health screenings. RESULTS: Among 730 eligible employees, 688 (94%) registered for the program, 571 (78%) completed a health screening at baseline, and 314 (43%) at 1 year. Most (66%) employees tracked their activity for more than 6 weeks. At 1-year follow-up, there were significant clinical improvements in systolic blood pressure -3.4 mm Hg, and reductions in poor sleep quality (33% to 28%), high emotional stress (21% to 15%), and fatigue (11% to 6%). A positive dose-response was noted where the greatest improvements were observed among those who participated the most. CONCLUSION: The program had high employee engagement. After 1 year, the benefits included clinically important improvements in physical and mental health.


Assuntos
Educação em Saúde , Promoção da Saúde , Estilo de Vida Saudável , Local de Trabalho , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Canadá , HDL-Colesterol/sangue , Exercício , Fadiga/prevenção & controle , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Avaliação de Programas e Projetos de Saúde , Sono , Estresse Psicológico/prevenção & controle
13.
Spine (Phila Pa 1976) ; 43(9): E531-E536, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28922278

RESUMO

STUDY DESIGN: Survey. OBJECTIVE: To define the critical elements of common spine surgeries. SUMMARY OF BACKGROUND DATA: Despite significant relevance to the field of spine surgery, the term "critical element" of surgery has not been clearly defined. Every surgical procedure involves numerous steps, each with its own potential for complications and harm to the patient. Despite its crucial role in surgical training, billing, and the ethicality of concurrent surgery, the term "critical element" of surgery has not been defined. METHODS: A survey was administered to surgeons associated with AO Spine North America and the Society for Minimally Invasive Spine Surgery to determine the critical elements for four common spine procedures: open lumbar laminectomy and fusion, microdiscectomy, anterior cervical discectomy and fusion (ACDF), and posterior cervical laminectomy and fusion. Respondents were asked which steps necessitated their direct supervision. Surgical subspecialty, level of experience, and practice demographics were also recorded. RESULTS: For all applicable procedures, decompression, instrumentation, and fusion were designated as critical elements. Patient positioning and fascial closure were not. Radiographic localization was considered critical for all procedures, except posterior cervical laminectomy and fusion. Exposure was not considered critical for any procedures, except ACDF. Certain substeps of decompression in ACDF and open lumbar laminectomy and fusion were not considered critical. Orthopaedic surgeons considered exposure and fusion in ACDF procedures to be critical whereas neurosurgeons did not. Surgeons operating in private practice considered every step of these common procedures to be critical elements. CONCLUSION: Decompression, instrumentation, and fusion were considered critical elements of common spine surgeries. There were significant differences in responses according to surgical specialty and practice setting. Future research is necessary to determine the implications of these findings and guide the definition of the "critical portions" of surgery. LEVEL OF EVIDENCE: 1.


Assuntos
Consenso , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Cirurgiões Ortopédicos/normas , Inquéritos e Questionários , Humanos , Procedimentos Neurocirúrgicos/métodos
14.
Stat Methods Med Res ; 27(4): 1271-1281, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-27587597

RESUMO

Background Biomarker series can indicate disease progression and predict clinical endpoints. When a treatment is prescribed depending on the biomarker, confounding by indication might be introduced if the treatment modifies the marker profile and risk of failure. Objective Our aim was to highlight the flexibility of a two-stage model fitted within a Bayesian Markov Chain Monte Carlo framework. For this purpose, we monitored the prostate-specific antigens in prostate cancer patients treated with external beam radiation therapy. In the presence of rising prostate-specific antigens after external beam radiation therapy, salvage hormone therapy can be prescribed to reduce both the prostate-specific antigens concentration and the risk of clinical failure, an illustration of confounding by indication. We focused on the assessment of the prognostic value of hormone therapy and prostate-specific antigens trajectory on the risk of failure. Methods We used a two-stage model within a Bayesian framework to assess the role of the prostate-specific antigens profile on clinical failure while accounting for a secondary treatment prescribed by indication. We modeled prostate-specific antigens using a hierarchical piecewise linear trajectory with a random changepoint. Residual prostate-specific antigens variability was expressed as a function of prostate-specific antigens concentration. Covariates in the survival model included hormone therapy, baseline characteristics, and individual predictions of the prostate-specific antigens nadir and timing and prostate-specific antigens slopes before and after the nadir as provided by the longitudinal process. Results We showed positive associations between an increased prostate-specific antigens nadir, an earlier changepoint and a steeper post-nadir slope with an increased risk of failure. Importantly, we highlighted a significant benefit of hormone therapy, an effect that was not observed when the prostate-specific antigens trajectory was not accounted for in the survival model. Conclusion Our modeling strategy was particularly flexible and accounted for multiple complex features of longitudinal and survival data, including the presence of a random changepoint and a time-dependent covariate.


Assuntos
Teorema de Bayes , Análise de Sobrevida , Idoso , Pesquisa Biomédica/estatística & dados numéricos , Progressão da Doença , Hormônios/uso terapêutico , Humanos , Masculino , Probabilidade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Falha de Tratamento
15.
Immun Inflamm Dis ; 6(1): 3-12, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29094518

RESUMO

INTRODUCTION: Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the differences in clinical characteristics and management of DIA between adults and children. OBJECTIVE: We assessed the percentage, diagnosis, and management of DIA among all anaphylaxis visits in three pediatric and one adult emergency departments (ED) across Canada. METHODS: Children presenting to the Montreal Children's Hospital (MCH), British Columbia Children's Hospital (BCCH), and Children's Hospital at London Health Sciences Center and adults presenting to Hôpital du Sacré-Coeur with anaphylaxis were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized data form documenting the reaction and management was completed and patients were followed annually to determine assessment by allergist and use of confirmatory tests. RESULTS: From June 2012 to May 2016, 51 children were recruited from the pediatric centers and 64 adults from the adult center with drug-induced anaphyalxis. More than half the cases were prospectively recruited. The percentage of DIA among all cases of anaphylaxis was similar in all three pediatric centers but higher in the adult center in Montreal. Most reactions in children were triggered by non-antibiotic drugs, and in adults, by antibiotics. The majority of adults and a third of children did not see an allergist after the initial reaction. In those that did see an allergist, diagnosis was established by either a skin test or an oral challenge in less than 20% of cases. CONCLUSIONS: Our results reveal disparities in rate, culprit, and management of DIA in children versus adults. Further, most cases of suspected drug allergy are not appropriately diagnosed. Guidelines to improve assessment and diagnosis of DIA are required.


Assuntos
Anafilaxia/epidemiologia , Hipersensibilidade a Drogas/epidemiologia , Serviço Hospitalar de Emergência , Adulto , Anafilaxia/terapia , Canadá/epidemiologia , Pré-Escolar , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Lactente , Masculino
16.
Neurology ; 89(17): 1795-1803, 2017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-28954882

RESUMO

OBJECTIVE: To assess effects of caffeine on Parkinson disease (PD). METHODS: In this multicenter parallel-group controlled trial, patients with PD with 1-8 years disease duration, Hoehn & Yahr stages I-III, on stable symptomatic therapy were randomized to caffeine 200 mg BID vs matching placebo capsules for 6-18 months. The primary research question was whether objective motor scores would differ at 6 months (Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale [MDS-UPDRS]-III, Class I evidence). Secondary outcomes included safety and tolerability, motor symptoms (MDS-UPDRS-II), motor fluctuations, sleep, nonmotor symptoms (MDS-UPDRS-I), cognition (Montreal Cognitive Assessment), and quality of life. RESULTS: Sixty patients received caffeine and 61 placebo. Caffeine was well-tolerated with similar prevalence of side effects as placebo. There was no improvement in motor parkinsonism (the primary outcome) with caffeine treatment compared to placebo (difference between groups -0.48 [95% confidence interval -3.21 to 2.25] points on MDS-UPDRS-III). Similarly, on secondary outcomes, there was no change in motor signs or motor symptoms (MDS-UPDRS-II) at any time point, and no difference on quality of life. There was a slight improvement in somnolence over the first 6 months, which attenuated over time. There was a slight increase in dyskinesia with caffeine (MDS-UPDRS-4.1+4.2 = 0.25 points higher), and caffeine was associated with worse cognitive testing scores (average Montreal Cognitive Assessment = 0.66 [0.01, 1.32] worse than placebo). CONCLUSION: Caffeine did not provide clinically important improvement of motor manifestations of PD (Class I evidence). Epidemiologic links between caffeine and lower PD risk do not appear to be explained by symptomatic effects. CLINICALTRIALSGOV IDENTIFIER: NCT01738178. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with PD, caffeine does not significantly improve motor manifestations.


Assuntos
Antiparkinsonianos/uso terapêutico , Cafeína/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
17.
Stat Med ; 36(30): 4843-4859, 2017 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-28875512

RESUMO

When multiple imperfect dichotomous diagnostic tests are applied to an individual, it is possible that some or all of their results remain dependent even after conditioning on the true disease status. The estimates could be biased if this conditional dependence is ignored when using the test results to infer about the prevalence of a disease or the accuracies of the diagnostic tests. However, statistical methods correcting for this bias by modelling higher-order conditional dependence terms between multiple diagnostic tests are not well addressed in the literature. This paper extends a Bayesian fixed effects model for 2 diagnostic tests with pairwise correlation to cases with 3 or more diagnostic tests with higher order correlations. Simulation results show that the proposed fixed effects model works well both in the case when the tests are highly correlated and in the case when the tests are truly conditionally independent, provided adequate external information is available in the form of fixed constraints or prior distributions. A data set on the diagnosis of childhood pulmonary tuberculosis is used to illustrate the proposed model.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Modelos Estatísticos , Técnicas Bacteriológicas/estatística & dados numéricos , Viés , Bioestatística , Criança , Simulação por Computador , Humanos , Bloqueio Interatrial , Radiografia Torácica , Teste Tuberculínico/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico
18.
J Otolaryngol Head Neck Surg ; 46(1): 55, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28851430

RESUMO

BACKGROUND: The proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology - Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs. METHOD: Anonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender. RESULTS: CaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years. CONCLUSIONS: Female representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender representation and identify barriers to prospective female OTL-HNS applicants.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Internato e Residência/estatística & dados numéricos , Otolaringologia/educação , Faculdades de Medicina/tendências , Razão de Masculinidade , Canadá , Escolha da Profissão , Bases de Dados Factuais , Feminino , Previsões , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Faculdades de Medicina/normas
19.
Vaccine ; 35(37): 5019-5026, 2017 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-28774563

RESUMO

BACKGROUND: Despite the approved use of live-attenuated intranasal influenza vaccine (LAIV) for seasonal immunization of patients with cystic fibrosis (CF), many questions remain unanswered regarding the timing, duration, and types of adverse events that occur following administration of this vaccine. METHODS: In 2012 and 2013, 264 LAIV doses were administered to 198 patients aged 2-19 with CF. Vaccinees were followed prospectively for 55 days after vaccination (day 0) and information on adverse events was collected. Bayesian change-point analysis was used to identify the risk period following LAIV during which participants had a higher risk of reporting adverse events. Multivariable zero-inflated Poisson regression models were then used to estimate the adjusted incidence rate ratio (aIRR) and 95% credible interval (CrI) of reporting each adverse event in the risk period versus the control period. RESULTS: There was a higher risk of reporting serious adverse events (SAEs) (aIRR 1.45, 95% CrI (0.29, 5.17)) and solicited symptoms during days 0-6 of follow-up compared to control period days 7-55. However, most SAEs were not causally related to LAIV and the solicited symptom episodes were brief, usually lasting 1-2 days. There was no increased risk of antibiotic prescriptions for respiratory conditions in the risk vs. control periods (aIRR 0.48, 95% CrI (0.23, 0.91)). CONCLUSIONS: Adverse events were most common 0-6 days after LAIV administration but were generally benign and self-limiting. Pulmonary exacerbations did not increase in frequency.


Assuntos
Fibrose Cística/imunologia , Fibrose Cística/virologia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Administração Intranasal , Adolescente , Teorema de Bayes , Criança , Feminino , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/imunologia , Masculino , Estudos Prospectivos , Vacinação/métodos
20.
J Rheumatol ; 44(10): 1484-1486, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28765255

RESUMO

OBJECTIVE: To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population. METHODS: Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI. RESULTS: A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups. CONCLUSION: Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Neoplasias/epidemiologia , Adolescente , Criança , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Sistema de Registros , Fatores Sexuais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA