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1.
JAMA ; 322(16): 1580-1588, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31638681

RESUMO

Importance: Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown. Objective: To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term. Design, Setting, and Participants: National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years). Exposures: Gestational age at birth. Main Outcomes and Measures: Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders. Results: In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, -0.41 [95% CI, -0.42 to -0.40; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, -0.50 [95% CI, -0.51 to -0.49; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Conclusions and Relevance: Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.


Assuntos
Comorbidade , Recém-Nascido Prematuro , Adolescente , Adulto , Estudos de Coortes , Epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Masculino , Distribuição de Poisson , Prevalência , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
2.
Bone Joint J ; 101-B(10): 1209-1217, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564156

RESUMO

AIMS: There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. PATIENTS AND METHODS: We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. RESULTS: During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. CONCLUSION: While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Causas de Morte , Mortalidade Hospitalar/tendências , Sistema de Registros , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , China , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
3.
Rev Saude Publica ; 53: 66, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553376

RESUMO

OBJECTIVE: To evaluate the performance of the ratio between the waist circumference and the height in the identification of health risk compared with the correlation matrix between the anthropometric parameters body mass index and waist circumference. METHODS: A population-based study presenting a transversal cut in a representative sample of the Brazilian adult and older population. The combination of the body mass index with the waist circumference resulted in health risk categories, and the cutoff points of the ratio between the waist circumference and the height as anthropometric indicator were used for classification of low and increased risk. Poisson regression was used to verify the association of systemic arterial hypertension with the health risk categories. RESULTS: The results showed 26% of adult men, 10.4% of adult women and more than 30% of the older adults of both genders classified as without risk by the combination matrix between body mass index and waist circumference presented a ratio between the waist circumference and height that showed increased risk. All risk categories continued to be associated with hypertension after control for confounding factors, being almost two times higher for adults with moderate and high risk according to both methods. When the waist-to-height ratio was used as a risk indicator, the prevalence of hypertension ratios for the older adults was 1.37 (95%CI 1.16-1.63) and 1.35 (95%CI 1.12-1.62) for men and women, respectively, being these values close to the combination matrix body mass index and waist circumference. CONCLUSIONS: The waist-to-height ratio identified more individuals at early health risk than the combination matrix between the body mass index and the waist circumference and showed comparable ability to identify health risk, regardless of gender and age, regarding the prevalence ratios for systemic arterial hypertension.


Assuntos
Sobrepeso/complicações , Medição de Risco/métodos , Razão Cintura-Estatura , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sobrepeso/fisiopatologia , Distribuição de Poisson , Valores de Referência , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Circunferência da Cintura , Adulto Jovem
4.
Rev Saude Publica ; 53: 76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553379

RESUMO

OBJECTIVE: To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS: This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT: Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001). CONCLUSIONS: The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.


Assuntos
Infecções por HIV/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sífilis Congênita/diagnóstico , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Distribuição de Poisson , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Prevalência , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde , Análise de Regressão , Fatores Socioeconômicos , Sífilis Congênita/epidemiologia
5.
Pan Afr Med J ; 33: 112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489090

RESUMO

Introduction: Animal bite injuries are a common public health concern in Uganda. We sought to characterize animal bite injuries among patients presenting to Mulago National Referral Hospital in Kampala, Uganda. Methods: This was a cross sectional study from 1st September to 30th November 2011. Participants were animal bite injury victims presenting to the accident and emergency (A&E) unit at Mulago hospital and were consecutively enrolled into the study. Socio-demographics, severity and patterns of injury, health seeking and dog handling behaviours were assessed using a standardized questionnaire. Descriptive statistics was used to summarize participant characteristics and the animal bite injuries. Poisson regression model's incident rate ratios (IRR) was used to explore the relationship of the number of days to accessing treatment at Mulago hospital with; a) received prior first aid, b) animal bite injury sustained during day time, c) unknown dog and d) victim resident in Kampala. Data were analyzed using STATA version 12.0 and statistical significance set at P < 0.05. Results: Of 25,420 patients that presented to the A&E unit during the study period, 207 (0.8%) had animal bite injuries, mean age 22.7 years (SD 14.3), 64.7% male, and 40.1% were <18 years. Majority 199 (96.1%) were bitten by a lone unrestrained and un-signaled dog that had bitten someone else in 22.2% of cases, and eight victims (0.4%) were attacked in canine gangs of 2-5 dogs. Rabies vaccination was confirmed in only 23 dogs (11.1%) as 109 (52.7%) were unknown to the victims or the communities. One hundred and eighteen victims (57.0%) sustained the dog bites within Kampala district whilst the rest occurred near or far from Kampala district, and the victims especially referred to access anti-rabies vaccine. Of 207, 189 victims (91.3%) presented within 2.6 days (SD ± 4.3). Two hundred victims (96.6%) sustained extremity injuries while the rest had injuries to other body parts. All injuries were minor and managed on out-patient basis with wound dressing, analgesics, prophylactic antibiotics and anti-rabies vaccination. Victims who received prior first aid had a rate of 1.7 times greater for seeking treatment at Mulago hospital (IRR 1.7, 95% CI 1.4-2.1) compared to those that had no prior first aid. Participants who sustained the animal bite injuries during day time had a rate of 1.6 times greater for seeking treatment at Mulago hospital (IRR 1.6, 95% CI 1.3-2.1) compared to those that sustained injuries at other times. Participants bitten by unknown dog and participants residing in Kampala had IRR 0.7, 95% CI 0.5-0.9 and IRR 0.6, 95% CI 0.5-0.8 respectively of accessing treatment at Mulago hospital compared to bitten by known dog and not residing in Kampala. Conclusion: Dog bites injuries from unrestrained, un-signaled dogs are the commonest source of animal bite injuries especially among children (<18 years). Vaccination against rabies was only confirmed for a very small number of dogs, as majority were unknown and likely stray dogs. Government and public sensitization is urgently required to limit stray dogs, vaccinate dogs and restrain them to prevent a grave probability of a looming canine rabies epidemic.


Assuntos
Mordeduras e Picadas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Vacinas Antirrábicas/administração & dosagem , Raiva/prevenção & controle , Adolescente , Adulto , Fatores Etários , Animais , Mordeduras e Picadas/terapia , Criança , Estudos Transversais , Doenças do Cão/prevenção & controle , Doenças do Cão/virologia , Cães , Feminino , Primeiros Socorros/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Masculino , Distribuição de Poisson , Inquéritos e Questionários , Fatores de Tempo , Uganda/epidemiologia , Adulto Jovem
6.
Rev Bras Epidemiol ; 22: e190044, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31432987

RESUMO

INTRODUCTION: Several factors can lead to changes in dietary practices of the older adults; which contributes with nutritional recommendations not being met. OBJECTIVES: To estimate the prevalence of inadequate dietary fiber consumption and to identify associated factors. METHODOLOGY: Population-based, cross-sectional study that used data from a health survey in the municipality of Campinas, SP, Brazil, held in 2008/2009, in which 1,509 individuals aged 60 or older were assessed. Food consumption was estimated through a 24-hour recall, and the prevalence of inadequacy was calculated according to the Institute of Medicine's cut-off point for total fiber (30 g/day for men and 21 g/day for women). Associated factors were identified using the hierarchical Poisson regression model to estimate the prevalence, adjusted for block distal (sociodemographic) and proximal variables (health and lifestyle indicators). RESULTS: Inadequate consumption was observed in 90.1% of the population, and after adjustments in the final model, this rate remained significantly higher among males (RP = 1.06), seniors with a partner (RP = 1.05), lower income (RP = 0.95), physically inactive (RP = 1.05) and those who would not like to change body weight (RP = 1.05). CONCLUSION: Considering that inadequacy of dietary fiber was very high, the whole 60-year-old or older population must be targeted for nutritional intervention in order to ensure adequate intake of this nutrient.


Assuntos
Inquéritos sobre Dietas/estatística & dados numéricos , Dieta/estatística & dados numéricos , Fibras na Dieta , Fatores Etários , Idoso , Brasil/epidemiologia , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Análise de Regressão , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários
7.
Braz Oral Res ; 33: e54, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365703

RESUMO

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.


Assuntos
Resinas Compostas/uso terapêutico , Amálgama Dentário/uso terapêutico , Reparação de Restauração Dentária/estatística & dados numéricos , Pigmentação da Pele , Adulto , Fatores Etários , Brasil , Estética Dentária/estatística & dados numéricos , Feminino , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Distribuição de Poisson , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 98(34): e16928, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441879

RESUMO

The consistent, sporadic transmission of shigellosis in Taiwan necessitates an exploration of risk factors for the occurrence of shigellosis. The purpose of this study was to study the epidemiologic characteristics and the relationship between climatic factors and the incidence of shigellosis in Taiwan. We collected data from cases of shigellosis reported to the Taiwan Centers for Disease Control (Taiwan CDC) from 2001 to 2016. Climatic data were obtained from the Taiwan Central Weather Bureau. The relationships between weather variability and the incidence of shigellosis in Taiwan were determined via Poisson regression analyses. During the 16-year study period, a total of 4171 clinical cases of shigellosis were reported to the Taiwan CDC. Among them, 1926 (46.2%) were classified as confirmed cases. The incidence of shigellosis showed significant seasonality, with the majority of cases occurring in summertime (for oscillation, P < .001). The number of shigellosis cases started to increase when temperatures reached 21°C (r = 0.88, P < .001). Similarly, the number of shigellosis cases began to increase at a relative humidity of 70-74% (r = 0.75, P < .005). The number of shigellosis cases was positively associated with the mean temperature and relative humidity in the period preceding the infection. In conclusion, the occurrence of shigellosis is significantly associated with increasing temperature and relative humidity in Taiwan. Therefore, these factors could be regarded as warning signals indicating the need to implement preventive measures.


Assuntos
Disenteria Bacilar/epidemiologia , Temperatura Alta/efeitos adversos , Umidade/efeitos adversos , Estações do Ano , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Vigilância da População , Taiwan/epidemiologia , Adulto Jovem
9.
Braz Oral Res ; 33: e033, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31269113

RESUMO

The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1ß, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1ß levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1ß and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1ß, IL-6 and IL-8.


Assuntos
Biomarcadores/análise , Paralisia Cerebral/complicações , Gengivite/complicações , Gengivite/reabilitação , Periodontite/terapia , Saliva/química , Adolescente , Criança , Citocinas/análise , Profilaxia Dentária/métodos , Feminino , Gengivite/microbiologia , Humanos , Interleucina-10 , Interleucina-1beta/análise , Interleucina-6/análise , Masculino , Concentração Osmolar , Índice Periodontal , Distribuição de Poisson , Saliva/imunologia , Saliva/microbiologia , Fator de Necrose Tumoral alfa/análise
10.
Prev Vet Med ; 169: 104701, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31311637

RESUMO

During the transition from late gestation to early lactation, dairy cattle are at increased risk for disease. Herd-level monitoring for disease risk involves evaluating multiple factors, including food intake, cow density, and biomarkers of nutrient metabolism. Biomarkers that are measured include non-esterified fatty acids (NEFA) and beta-hydroxybutyrate (BHB), which are usually measured in a subset of the herd (i.e. cohort). If a certain proportion of cows in the cohort are above a specific threshold for a biomarker, the cohort is considered at high risk of disease. Few previous studies have investigated other methods to aggregate individual cow-level data to the cohort level. We designed a proof-of-concept study to determine if biomarker aggregation methods may be useful to predict cohort incidence of adverse health events including 1) clinical diseases: mastitis, metritis, retained placenta, ketosis, lameness, pneumonia, milk fever, displaced abomasum, 2) and abortion or death of the calf or the cow. The study design was a prospective cohort study that used cows (N = 277) from five Michigan commercial dairy herds. Multiple cohorts of cows (two to four cohorts per farm, 18 total) were enrolled that shared the same dry-off date. We tested three different methods (central, dispersion, and count) to aggregate individual cow data (i.e. biomarkers and covariates) measured at dry-off. The central method consisted of calculating the average value of each variable within a cohort, and the dispersion method involved taking the standard deviation or mean absolute deviation about the median of each variable within a cohort. The count method consisting of counting the number of cows above a specific threshold for each variable within a cohort. We used best subsets selection to select a bouquet of candidate models for each aggregation method and averaged the predictions over the model set. We built 4 sets of Poisson regression models: one for each aggregation method and a combined model that included all three methods. We evaluated the models based on goodness-of-fit, model calibration using scoring rules, and comparison of observed versus predicted counts. The central and the combined method produced models that had good fit and model calibration. These results indicate that it may be possible to use aggregate measures to predict cohort disease incidence as early as dry-off. The next step is to test biomarker aggregation methods in studies with larger sample sizes.


Assuntos
Biomarcadores/sangue , Doenças dos Bovinos/sangue , Doenças dos Bovinos/epidemiologia , Ácido 3-Hidroxibutírico/sangue , Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Estudos de Coortes , Indústria de Laticínios , Ácidos Graxos não Esterificados/sangue , Feminino , Incidência , Mastite Bovina/diagnóstico , Mastite Bovina/epidemiologia , Michigan/epidemiologia , Estresse Oxidativo , Placenta Retida , Distribuição de Poisson , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade
11.
Pan Afr Med J ; 32: 206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312318

RESUMO

Introduction: Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods: We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results: Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion: The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.


Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/epidemiologia , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Estudos de Coortes , Coinfecção , Feminino , Gana/epidemiologia , Infecções por HIV/mortalidade , Soropositividade para HIV/epidemiologia , Hospitais Urbanos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Tuberculose/mortalidade , Adulto Jovem
12.
Braz J Infect Dis ; 23(4): 231-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31351815

RESUMO

INTRODUCTION: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. OBJECTIVE: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. METHODS: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. RESULTS: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. CONCLUSIONS: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Pessoal de Saúde/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos , Adulto , Brasil , Feminino , Humanos , Programas de Imunização/métodos , Masculino , Análise Multivariada , Distribuição de Poisson , Vigilância da População , Fatores de Tempo , Local de Trabalho/estatística & dados numéricos
13.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 295-301, Apr.-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1013134

RESUMO

Abstract Objectives: to analyze the difference among geographical units and the evolution of infant mortality rate (IMR) based on Ecuadorian censuses (1990-2001-2010). Methods: artificial Neural Network analyzed the impact of sociodemographic factors over the variability of IMR. Poisson regression analyzed the variation of the standardized IMR (sIMR). Results: the decrease in the national IMR was 63.8%; however, 42.8% provinces showed an increase in 2001-2010. The variability was explained mainly by illiteracy decrease. The adjusted RR between provincial sIMR with illiteracy and poverty revealed a trend towards the unit. Conclusions: the variation of IMR reflects a complex interaction of the sociodemographic factors.


Resumen Objetivos: analizar las diferencias de la evolución de la tasa de mortalidad infantil (TMI) entre unidades geográficas basada en los censos ecuatorianos (1990-2001-2010). Métodos: la red neuronal artificial analizó el impacto de los factores sociodemográficos sobre la variabilidad de la TMI. La regresión de Poisson analizó la cuantificación de la variación de la TMI estandarizada (TMIs). Resultados: la disminución en la TMI nacional fue de 63.8%; sin embargo, 42.8% de las provincias mostraron un incremento en el periodo 2001-2010. La variabilidad se explica principalmente por la disminución del analfabetismo. El RR ajustado entre TMIs provincial con analfabetismo y pobreza reveló una tendencia hacia la unidad. Conclusiones: la variación de la TMI refleja una interacción compleja de los factores sociodemográficos estudiados.


Assuntos
Criança , Pobreza , Fatores Socioeconômicos , Mortalidade Infantil , Morbidade , Distribuição de Poisson , Redes Neurais (Computação) , Equador , Alfabetização
14.
Parasitol Int ; 72: 101944, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31220635

RESUMO

Climate change and other weather factors are associated with several infectious diseases, but are rarely reported as being associated with nematode infection. Eosinophilic meningitis (EOM) is an emerging disease worldwide caused by the nematode, Angiostrongylus cantonensis. It is transmitted through various agents such as snails and slugs. Temperature and rainfall are associated with snail population. There have been no previous studies on the relationship between weather and EOM. This was an ecological study. Numbers of EOM patients and weather data in Thailand's Loei province from 2006 to 2017 were obtained using a national database. A Spearman correlation was used to explore the relationship between EOM and weather variables. We developed a Poisson time series model combined with a distributed lag model (DLM) for estimating the effects of weather on EOM. We also created an autoregressive integrated moving average with exogeneous variable (ARIMAX) model for predicting future EOM cases over the following 12 months. There were 1126 EOM patients in the study. Among several weather factors, wind was significantly negatively correlated with the number of EOM patients (rs: -0.204, 95% CI: -0.361 to -0.058; p value: 0.014). The ARIMAX(3, 0, 0) model with wind speed as a variable was appropriate for predicting the number of EOM patients. The predicted and actual numbers of EOM patients in 2018 were highly concordant. In conclusion, wind speed is significantly negatively correlated with the number of EOM patients.


Assuntos
Ecossistema , Eosinofilia/parasitologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Tempo (Meteorologia) , Vento , Angiostrongylus cantonensis/isolamento & purificação , Animais , Mudança Climática , Humanos , Meningite/epidemiologia , Distribuição de Poisson , Caramujos/parasitologia , Infecções por Strongylida/complicações , Temperatura Ambiente , Tailândia/epidemiologia
15.
JAMA ; 322(2): 145-152, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31211826

RESUMO

Importance: Recent evidence suggests that cannabis use during pregnancy is increasing, although population-based data about perinatal outcomes following in utero exposure remain limited. Objective: To assess whether there are associations between self-reported prenatal cannabis use and adverse maternal and perinatal outcomes. Design, Setting, and Participants: Population-based retrospective cohort study covering live births and stillbirths among women aged 15 years and older in Ontario, Canada, between April 2012 and December 2017. Exposures: Self-reported cannabis exposure in pregnancy was ascertained through routine perinatal care. Main Outcomes and Measures: The primary outcome was preterm birth before 37 weeks' gestation. Indicators were defined for birth occurring at 34 to 36 6/7 weeks' gestation (late preterm), 32 to 33 6/7 weeks' gestation, 28 to 31 6/7 weeks' gestation, and less than 28 weeks' gestation (very preterm birth). Ten secondary outcomes were examined including small for gestational age, placental abruption, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference (RD) and relative risk (RR) of outcomes associated with cannabis exposure and control for confounding. Results: In a cohort of 661 617 women, the mean gestational age was 39.3 weeks and 51% of infants were male. Mothers had a mean age of 30.4 years and 9427 (1.4%) reported cannabis use during pregnancy. Imbalance in measured maternal obstetrical and sociodemographic characteristics between reported cannabis users and nonusers was attenuated using matching, yielding a sample of 5639 reported users and 92 873 nonusers. The crude rate of preterm birth less than 37 weeks' gestation was 6.1% among women who did not report cannabis use and 12.0% among those reporting use in the unmatched cohort (RD, 5.88% [95% CI, 5.22%-6.54%]). In the matched cohort, reported cannabis exposure was significantly associated with an RD of 2.98% (95% CI, 2.63%-3.34%) and an RR of 1.41 (95% CI, 1.36-1.47) for preterm birth. Compared with no reported use, cannabis exposure was significantly associated with greater frequency of small for gestational age (third percentile, 6.1% vs 4.0%; RR, 1.53 [95% CI, 1.45-1.61]), placental abruption (1.6% vs 0.9%; RR, 1.72 [95% CI, 1.54-1.92]), transfer to neonatal intensive care (19.3% vs 13.8%; RR, 1.40 [95% CI, 1.36-1.44]), and 5-minute Apgar score less than 4 (1.1% vs 0.9%; RR, 1.28 [95% CI, 1.13-1.45]). Conclusions and Relevance: Among pregnant women in Ontario, Canada, reported cannabis use was significantly associated with an increased risk of preterm birth. Findings may be limited by residual confounding.


Assuntos
Cannabis , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Ontário/epidemiologia , Distribuição de Poisson , Gravidez , Nascimento Prematuro/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Autorrelato , Estados Unidos , Adulto Jovem
16.
Rev Bras Epidemiol ; 22: e190031, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038612

RESUMO

OBJECTIVE: To describe and evaluate the factors associated with actions for the control of tuberculosis (TB) in primary care (PC) in the five Brazilian macroregions. METHODS: This cross-sectional study was carried out with data from the second cycle of the National Program for Improving Access to and Quality of Primary Care. Theoutcome of the study was constructed based on a set of items that were considered essential for the treatment and control of tuberculosis in Primary Care Units (PCUs). Data were analyzed using the χ2 test and Poisson regression with robust variance. RESULTS: The national prevalence of the set of items to control tuberculosis was 17.22%. TheNortheast (11.18%) and North (12.15%) had the worst performance. The main results indicate association with this outcome for PCUs performing educational actions for TB (PR = 1.53; 95%CI 1.45 - 1.62), those performing HIV serology (PR = 1.68; 95%CI 1.11 - 2.54), those that have a reception room (PR = 1.61; 95%CI 1.46 - 1.79) and those performing continuing education activities (PR = 1.73; 95%CI 1.54 - 1.95). CONCLUSION: The results show a weakness in the structures and in the work process of PC in relation to the control of tuberculosis in all Brazilian regions.


Assuntos
Atenção Primária à Saúde/estatística & dados numéricos , Tuberculose/prevenção & controle , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Avaliação de Resultados (Cuidados de Saúde) , Distribuição de Poisson , Qualidade da Assistência à Saúde
17.
Phys Rev E ; 99(4-1): 042402, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31108645

RESUMO

Temporal correlations in neuronal spike trains are known to introduce redundancy to stimulus encoding. However, exact methods to describe how these correlations impact neural information transmission quantitatively are lacking. Here, we provide a general measure for the information carried by correlated rate modulations only, neglecting other spike correlations, and use it to investigate the effect of rate correlations on encoding redundancy. We derive it analytically by calculating the mutual information between a time-correlated, rate modulating signal and the resulting spikes of Poisson neurons. Whereas this information is determined by spike autocorrelations only, the redundancy in information encoding due to rate correlations depends on both the distribution and the autocorrelation of the rate histogram. We further demonstrate that at very small signal strengths the information carried by rate correlated spikes becomes identical to that of independent spikes, in effect measuring the signal modulation depth. In contrast, a vanishing signal correlation time maximizes information but does not generally yield the information of independent spikes. Overall, our study sheds light on the role of signal-induced temporal correlations for neural coding, by providing insight into how signal features shape redundancy and by establishing mathematical links between existing methods.


Assuntos
Modelos Neurológicos , Neurônios/citologia , Cinética , Distribuição de Poisson
18.
BMC Public Health ; 19(1): 594, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101045

RESUMO

BACKGROUND: Intimate partner violence (IPV), HIV and sexually transmitted infections (STI) can contribute to disparities in population health, depending on the individual, social and environmental factors characterizing a setting. To better understand the place-based determinants and patterns of these key interrelated public health problems in Uganda, we compared risk factors for IPV, HIV and STI in fishing, trading and agrarian communities in Rakai, Uganda by gender. METHOD: This study used cross-sectional data collected from 14,464 sexually active men (n = 6531) and women (n = 7933) as part of the Rakai Community Cohort Study, a population-based open cohort study of men and women aged 15-49 years. We used multilevel modified poisson regression models, which incorporated random intercepts for community and households. Factors associated with IPV, HIV and STI were assessed separately for men and women in fishing, trading and agrarian communities. RESULTS: A larger proportion of participants in the fishing communities than those in trading and agrarian communities were HIV positive, engaged in HIV risk behaviors, had STI symptoms and reported perpetration of or victimization by IPV. Female gender was a shared correlate of IPV, HIV and STI in the fishing communities. Engagement in multiple sexual relationships or partner's engagement in multiple relationships were shared correlates of IPV, and HIV in agrarian communities and IPV and STI in trading communities. CONCLUSION: Programs should target factors at multiple levels to reduce risk for syndemic conditions of HIV, STI and IPV in Rakai, Uganda particularly among men and women in fishing communities.


Assuntos
Agricultura , Infecções por HIV/epidemiologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Fatores Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Mercantilização , Estudos Transversais , Feminino , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Análise de Regressão , Fatores de Risco , Parceiros Sexuais , Uganda/epidemiologia , Adulto Jovem
19.
Braz J Infect Dis ; 23(2): 95-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059675

RESUMO

BACKGROUND: The prevalence of keratoconjunctivitis sicca (KCS) associated with Human T-Cell Lymphotropic Virus Type 1 (HTLV-1) (HTLV-1/KCS) has been estimated at around 37%, but its clinical manifestations are poorly described. PURPOSE: To determine the prevalence and associated factors of HTLV-1/KCS in a large cohort of HTLV-1-infected individuals living in Salvador, Brazil. METHODS: A cross-sectional study was conducted between June 2004 and September 2017 at the Integrative and Multidisciplinary Center for HTLV in Salvador, Bahia-Brazil. Data from 758 HTLV-1-infected patients was collected. A complete ophthalmologic examination was performed in both eyes. Lacrimal function was evaluated by breakup time, Rose Bengal and Schirmer I Tests. KCS diagnosis was considered in the presence of at least two out of three positive tests. HTLV-1 proviral load Crude and Adjusted Prevalence Rates (PR) with 95% Confidence Intervals (95% CI) were estimated using multivariate Poisson Regression with robust error variance. RESULTS: The overall prevalence of KCS was 31.7%, with higher rates observed in HTLV-1-associated myelopathy/tropical spastic paraparesis patients (crude PR: 1.84; CI95%: 1.50-2.26) even after adjusting for age, sex, time of HTLV-1 diagnosis and schooling (adjusted PR: 1.63; CI95%: 1.31-2.02). Proviral load, low corrected visual acuity, burning and/or pain and itching were all significantly higher in patients with KCS. CONCLUSION: Burning and/or pain and itching and low corrected visual acuity were the most common alterations of HTLV-1/KCS. High Proviral load was found to be associated with the presence of KCS. It is strongly recommended that HTLV-1 patients undergo periodic ophthalmologic examination to promote the early diagnosis of KCS and prevent the consequences associated with dry eye disease.


Assuntos
Vírus Linfotrópico T Tipo 1 Humano/patogenicidade , Ceratoconjuntivite Seca/epidemiologia , Ceratoconjuntivite Seca/virologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , DNA Viral , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ceratoconjuntivite Seca/patologia , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores Sexuais , Fatores Socioeconômicos , Carga Viral , Adulto Jovem
20.
Medicine (Baltimore) ; 98(21): e15769, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124966

RESUMO

INTRODUCTION: Health services utilization is an indirect measure of the rights and equity of a health system. A 2015 survey conducted in the Manaus metropolitan region showed that in the previous year, over 70% of adults visited the doctor and 1 in 3 had visited a dentist. Socioeconomic factors and inequality played a central role in the usage of healthcare services and health situation in this population. Since then, political and economic crisis are evolving in Brazil. This project aims to estimate the prevalence of use of health services and the health status of the adults residing in Manaus in 2019. METHODS AND ANALYSIS: This is a population-based survey of adults (≥18 years old) residing in Manaus. This survey will be conducted in the first half of 2019 with 2300 participants who will be interviewed at home, selected from a probabilistic sampling in 3 stages (census tracts, household, and dweller), and stratified by sex and age quotas based on official estimates. The participants will be interviewed using previously validated tools and questions employed in Brazilian official surveys, which will cover use of health services and supplies, health status, and lifestyle. Primary outcome will be any healthcare usage in the last 15 days. Associations between health services usage and socioeconomic data and health outcomes will be assessed using a Poisson regression with a complex sampling design correction. Results will be reported according to the strengthening the reporting of observational studies in epidemiology statement. ETHICS AND DISSEMINATION: This project was approved by the Ethics Committee of the Federal University of Amazonas, Manaus, Amazonas, Brazil. All participants will sign an informed consent before the interview. The results will be disseminated in peer-reviewed manuscripts, reports, conference presentations, and through the media.


Assuntos
Pesquisas sobre Serviços de Saúde/métodos , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Nível de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Análise de Regressão , Projetos de Pesquisa , Fatores Socioeconômicos , Adulto Jovem
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