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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 1006-1009, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484270

RESUMO

Logistic regression has been recognized as a commonly used method in epidemiological studies. However, in practice, many people only consider 'data' rather than 'study design' as important issue when working on the analysis, which may easily lead to some misleading results and conclusions. Based on the purpose of observational research during the design of the study, this paper discusses the specific ideas in logistic regression analysis, and provides references for the practical application when logistic regression method is used.


Assuntos
Métodos Epidemiológicos , Estudos Epidemiológicos , Modelos Logísticos , Estudos Observacionais como Assunto , Humanos , Observação , Projetos de Pesquisa
2.
Rev Bras Epidemiol ; 22: e190051, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31553358

RESUMO

INTRODUCTION: The prevalence of depression is high in the prison system, and the differences between sex regarding associated risk factors are still not clear. We analyzed the correlated factors of depression among incarcerated men and women in the state of São Paulo, Brazil. METHODOLOGY: A cross-sectional study with stratified and multi-stage probabilistic sample was performed. Composite International Diagnostic Interview (CIDI) was applied for psychiatric diagnostic classification, as well as a questionnaire on criminal history with 1,192 men and 617 women. Lifetime prevalence of mental disorder was calculated, and association analysis performed by multinomial logistic regression stratified by sex. A dependent variable was categorized into depression, any other mental disorder and no mental disorder (reference). RESULTS: The prevalence of depression was of 33.3% -(30.3 - 36.5) in women and 12.9% (11.1 - 15.0) in men. Depression was associated with disciplinary penalty, being in a stable relationship, physical health problems and history of infringement in adolescence in men. Regarding other mental illnesses, the correlated factors were historical transgression during adolescence and re-offense. Among women, depression was associated with physical health problems, drug crimes, violent crimes and being imprisoned. DISCUSSION: Results confirmed the differences between associated factors with depression regarding sex. CONCLUSION: Differences in the profile between men and women require effective specialized programs, considering the need for coping strategies for incarcerated men and health-related rehabilitation for women with depression.


Assuntos
Depressão/epidemiologia , Prisioneiros/psicologia , Adolescente , Adulto , Brasil/epidemiologia , Criminosos/psicologia , Criminosos/estatística & dados numéricos , Depressão/diagnóstico , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prisioneiros/estatística & dados numéricos , Fatores Sexuais , Violência/estatística & dados numéricos , Adulto Jovem
3.
Rev Saude Publica ; 53: 52, 2019 Jul 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269091

RESUMO

OBJECTIVE: To investigate the relationship between the dietary patterns of pregnant women with maternal excessive body weight and gestational diabetes mellitus. METHODS: A cross-sectional study conducted with a convenience sample of 785 adult pregnant women attended by the Unified Health System of Ribeirão Preto, state of São Paulo, between 2011 and 2012. Two 24-hour dietary recalls, corrected by the multiple source method, were employed . For the classification of the body mass index and the diagnosis of gestational diabetes mellitus, the criteria by Atalah and the World Health Organization were used, respectively. Dietary patterns were obtained by principal component analysis using the Varimax rotation method. The relationship between adherence to patterns, overweight and obesity was analyzed by multinomial logistic regression models and the relationship with gestational diabetes mellitus by adjusted unconditional logistic regression models. RESULTS: We identified four dietary patterns: "traditional Brazilian"; "snacks"; "coffee" and "healthy". Women with a higher adherence to the "Healthy" (OR = 0.52; 95%CI 0.33-0.83) and "Brazilian Traditional" patterns (OR = 0.61; 95%CI 0.38-0.96) presented a lower chance of obesity, when compared to women with lower adherence, regardless of confounding factors. After adjustment for maternal excessive body weight, there was no association between dietary patterns and gestational diabetes mellitus. CONCLUSIONS: Among the pregnant women, greater adherence to "traditional Brazilian" and "healthy" patterns was inversely associated with obesity, but no relationship was identified with gestational diabetes mellitus after adjusting for excessive body weight. Prospective studies are recommended to investigate the relationship between dietary patterns, overweight and gestational diabetes mellitus, reducing the chance of reverse causality.


Assuntos
Diabetes Gestacional/etiologia , Dieta/efeitos adversos , Obesidade/complicações , Sobrepeso/complicações , Adulto , Índice de Massa Corporal , Brasil , Métodos Epidemiológicos , Comportamento Alimentar , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Ganho de Peso , Adulto Jovem
5.
Braz Oral Res ; 33: e056, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31271568

RESUMO

The aim of this study was to assess the association between weight status and ΔDMFS among 12-year-old schoolchildren from South Brazil. A total of 801 12-year-old schoolchildren were followed-up for 2.5 ± 0.3 years. Data collection included questionnaire, recording of anthropometric measures (height and weight), and caries examination. The outcome was the difference between DMFS (number of decayed, missing or filled surfaces) at follow-up and baseline (ΔDMFS). Weight status, based on body mass index-for-age Z-scores, was considered the main predictor variable. Negative binomial regression models were used to model the association, and rate ratios and their 95% confidence intervals were estimated. A multivariable fractional polynomial model was used to further explore the relationship between obesity and dental caries. DMFS increased by 0.86 (95%CI = 0.65-1.07), 0.91 (95%CI = 0.59-1.23), and 0.42 (95%CI = 0.03-0.80) for normal weight, overweight, and obese schoolchildren, respectively. Obese adolescents had significantly lower ΔDMFS than normal weight ones (p < 0.05). No significant association between categories of weight status and ΔDMFS was found (overweight, IRR=0.92, 95%CI = 0.69-1.21, p = 0.54; obese IRR = 0.75, 95%CI = 0.51-1.12, p = 0.16). However, the multivariable fractional polynomial model showed an inverted U shaped relationship with a decreasing ΔDMFS with increasing BMI (p < 0.05). This population-based longitudinal study showed an inverse association between obesity and ΔDMFS over a 2.5-year period among South Brazilian adolescents.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Obesidade/complicações , Obesidade/epidemiologia , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Índice CPO , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Sobrepeso/complicações , Sobrepeso/epidemiologia , Fatores Socioeconômicos
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 571-573, 2019 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-31177740

RESUMO

Objective: To analyze the epidemiological characteristics and response process of an acute poisoning event caused by carbofuran in buttered tea and provide scientific evidence for the investigation of similar events in the future. Methods: Field epidemiological survey, animal experiments and laboratory tests were conducted for an acute poisoning event occurred in Suopo township of Danba county of Sichuan province in 2018. Descriptive epidemiological method was used to analyze the epidemiological characteristics of the acute poisoning event. Results: A total of 26 poisoning cases occurred in 3 villages. The total attack rate was 41.27%. No death cases were reported. The 26 cases occurred in a few minutes after drinking buttered tea, the main symptoms were vomit, dizziness, miosis and nausea. A dog showed the same symptoms after drinking a sample of buttered tea. Carbofuran was detected in buttered tea, vomitus and zanba samples. Conclusions: The acute poisoning was caused by carbofuran in buttered tea, the transmission mode was point source spread. Effective epidemiological investigation and simple animal experiment can provide evidence for the rapid sample detection and clinical treatment of cases in emergency response. Timely case treatment and strict poisoning source control are the key measures to reduce casualty and prevent the spread of poisoning.


Assuntos
Carbofurano/envenenamento , Inseticidas/envenenamento , Envenenamento/epidemiologia , Chá/efeitos adversos , Doença Aguda , Animais , Tontura/etiologia , Métodos Epidemiológicos , Humanos , Miose/etiologia , Náusea/etiologia , Vômito/etiologia
7.
Malar J ; 18(1): 195, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186004

RESUMO

BACKGROUND: The disease burden of Plasmodium falciparum malaria illness is generally estimated using one of two distinct approaches: either by transforming P. falciparum infection prevalence estimates into incidence estimates using conversion formulae; or through adjustment of counts of recorded P. falciparum-positive fever cases from clinics. Whilst both ostensibly seek to evaluate P. falciparum disease burden, there is an implicit and problematic difference in the metric being estimated. The first enumerates only symptomatic malaria cases, while the second enumerates all febrile episodes coincident with a P. falciparum infection, regardless of the fever's underlying cause. METHODS: Here, a novel approach was used to triangulate community-based data sources capturing P. falciparum infection, fever, and care-seeking to estimate the fraction of P. falciparum-positive fevers amongst children under 5 years of age presenting at health facilities that are attributable to P. falciparum infection versus other non-malarial causes. A Bayesian hierarchical model was used to assign probabilities of malaria-attributable fever (MAF) and non-malarial febrile illness (NMFI) to children under five from a dataset of 41 surveys from 21 countries in sub-Saharan Africa conducted between 2006 and 2016. Using subsequent treatment-seeking outcomes, the proportion of MAF and NMFI amongst P. falciparum-positive febrile children presenting at public clinics was estimated. RESULTS: Across all surveyed malaria-positive febrile children who sought care at public clinics across 41 country-years in sub-Saharan Africa, P. falciparum infection was estimated to be the underlying cause of only 37.7% (31.1-45.4, 95% CrI) of P. falciparum-positive fevers, with significant geographical and temporal heterogeneity between surveys. CONCLUSIONS: These findings highlight the complex nature of the P. falciparum burden amongst children under 5 years of age and indicate that for many children presenting at health clinics, a positive P. falciparum diagnosis and a fever does not necessarily mean P. falciparum is the underlying cause of the child's symptoms, and thus other causes of illness should always be investigated, in addition to prescribing an effective anti-malarial medication. In addition to providing new large-scale estimates of malaria-attributable fever prevalence, the results presented here improve comparability between different methods for calculating P. falciparum disease burden, with significant implications for national and global estimation of malaria burden.


Assuntos
Coinfecção/epidemiologia , Efeitos Psicossociais da Doença , Febre/epidemiologia , Malária Falciparum/complicações , África ao Sul do Saara/epidemiologia , Pré-Escolar , Métodos Epidemiológicos , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Prevalência
8.
BMC Health Serv Res ; 19(1): 345, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146744

RESUMO

BACKGROUND: Whether patients receive low-value hospital care (care that is not expected to provide a net benefit) may be influenced by unmeasured factors at the hospital they attend or the hospital's Local Health District (LHD), or the patients' areas of residence. Multilevel modelling presents a method to examine the effects of these different levels simultaneously and assess their relative importance to the outcome. Knowing which of these levels has the greatest contextual effects can help target further investigation or initiatives to reduce low-value care. METHODS: We conducted multilevel logistic regression modelling for nine low-value hospital procedures. We fit a series of six models for each procedure. The baseline model included only episode-level variables with no multilevel structure. We then added each level (hospital, LHD, Statistical Local Area [SLA] of residence) separately and used the change in the c statistic from the baseline model as a measure of the contribution of the level to the outcome. We then examined the variance partition coefficients (VPCs) and median odds ratios for a model including all three levels. Finally, we added level-specific covariates to examine if they were associated with the outcome. RESULTS: Analysis of the c statistics showed that hospital was more important than LHD or SLA in explaining whether patients receive low-value care. The greatest increases were 0.16 for endoscopy for dyspepsia, 0.13 for colonoscopy for constipation, and 0.14 for sentinel lymph node biopsy for early melanoma. SLA gave a small increase in c compared with the baseline model, but no increase over the model with hospital. The VPCs indicated that hospital accounted for most of the variation not explained by the episode-level variables, reaching 36.8% (95% CI, 31.9-39.0) for knee arthroscopy. ERCP (8.5%; 95% CI, 3.9-14.7) and EVAR (7.8%; 95% CI, 2.9-15.8) had the lowest residual variation at the hospital level. The variables at the hospital, LHD and SLA levels that were available for this study generally showed no significant effect. CONCLUSIONS: Investigations into the causes of low-value care and initiatives to reduce low-value care might best be targeted at the hospital level, as the high variation at this level suggests the greatest potential to reduce low-value care.


Assuntos
Assistência à Saúde/normas , Hospitalização , Hospitais/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Colonoscopia/estatística & dados numéricos , Transtornos de Deglutição/etiologia , Assistência à Saúde/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , New South Wales , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 343, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146790

RESUMO

BACKGROUND: Health care on equal terms is a cornerstone of the Swedish health care system. Total hip arthroplasty (THA) is considered a success story in Sweden with low frequency of reoperations and restored health-related quality of life (HRQoL). Administratively, health care in Sweden is locally self-governed by 21 counties. In this longitudinal nation-wide observational study we assessed the possible geographical variations in 1-year follow-up patient-reported outcomes (PROs): EQ-5D index, EQ VAS, Pain VAS and Satisfaction VAS. METHODS: Study population consisted of 36,235 Swedish THA patients, operated during 2008 to 2012 due to hip osteoarthritis. Individual data came from Swedish Hip Arthroplasty Register, Statistics Sweden and National Board of Health and Welfare. We used descriptive statistics together with multivariable regression analysis to analyse the data. RESULTS: We observed county level differences in both preoperative and postoperative PROs. The results showed that the differences observed in preoperative PROs could not fully explain the differences observed in postoperative PROs, even after adjustment for patient demographics (age, sex, BMI, Elixhauser comorbidity index, marital status, educational level and disposable income). This indicates that other factors might influence the outcome after THA. CONCLUSION: Likely, structural and process differences such as indication for surgery have an influence on PROs after surgery. Standardization of care at hospital levels may decrease geographical variations in postoperative HRQoL. Remaining differences will then possibly be associated to patient demographics.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Osteoartrite do Quadril/cirurgia , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Osteoartrite do Quadril/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Reoperação/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Suécia/epidemiologia , Escala Visual Analógica
10.
BMC Public Health ; 19(Suppl 2): 478, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159761

RESUMO

BACKGROUND: The last few years have seen renewed interest in use-of-time recalls in epidemiological studies, driven by a focus on the 24-h day [including sleep, sitting, and light physical activity (LPA)] rather than just moderate-vigorous physical activity (MVPA). This paper describes four different computerised use-of-time instruments (ACT24, PAR, MARCA and cpar24) and presents population time-use data from a collective sample of 8286 adults from different population studies conducted in Australia/New Zealand, Germany and the United States. METHODS: The instruments were developed independently but showed a number of similarities: they were self-administered through the web or used computer-assisted telephone interviews; all captured energy expenditure using variants of the Ainsworth Compendium; each had been validated against criterion measures; and they used a domain structure whereby activities were aggregated under categories such as Personal Care and Work. RESULTS: Estimates of physical activity level (average daily rate of energy expenditure in METs) ranged from 1.53 to 1.78 in the four studies, strikingly similar to population estimates derived from doubly labelled water. There was broad agreement in the amount of time spent in sleep (7.2-8.6 h), MVPA (1.6-3.1 h), personal care (1.6-2.4 h), and transportation (1.1-1.8 h). There were consistent sex differences, with women spending 28-81% more time on chores, 8-40% more time in LPA, and 3-39% less time in MVPA than men. CONCLUSIONS: Although there were many similarities between instruments, differences in operationalizing definitions of sedentary behaviour and LPA resulted in substantive differences in the amounts of time reported in sedentary and physically active behaviours. Future research should focus on deriving a core set of basic activities and associated energy expenditure estimates, an agreed classificatory hierarchy for the major behavioural and activity domains, and systems to capture relevant social and environmental contexts.


Assuntos
Acelerometria/psicologia , Exercício/psicologia , Rememoração Mental , Comportamento Sedentário , Estudos de Tempo e Movimento , Acelerometria/métodos , Adulto , Austrália , Computadores , Metabolismo Energético , Métodos Epidemiológicos , Estudos Epidemiológicos , Feminino , Alemanha , Humanos , Masculino , Nova Zelândia , Reprodutibilidade dos Testes , Fatores Sexuais , Sono , Fatores de Tempo , Transportes , Estados Unidos
11.
BMC Bioinformatics ; 20(1): 312, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185887

RESUMO

BACKGROUND: Mathematical and computational models are widely used to study the transmission, pathogenicity, and propagation of infectious diseases. Unfortunately, complex mathematical models are difficult to define, reuse and reproduce because they are composed of several concerns that are intertwined. The problem is even worse for computational models because the epidemiological concerns are also intertwined with low-level implementation details that are not easily accessible to non-computing scientists. Our goal is to make compartmental epidemiological models easier to define, reuse and reproduce by facilitating implementation of different simulation approaches with only very little programming knowledge. RESULTS: We achieve our goal through the definition of a domain-specific language (DSL), Kendrick, that relies on a very general mathematical definition of epidemiological concerns as stochastic automata that are combined using tensor-algebra operators. A very large class of epidemiological concerns, including multi-species, spatial concerns, control policies, sex or age structures, are supported and can be defined independently of each other and combined into models to be simulated by different methods. Implementing models does not require sophisticated programming skills any more. The various concerns involved within a model can be changed independently of the others as well as reused within other models. They are not plagued by low-level implementation details. CONCLUSIONS: Kendrick is one of the few DSLs for epidemiological modelling that does not burden its users with implementation details or required sophisticated programming skills. It is also currently the only language for epidemiology modelling that supports modularity through clear separation of concerns hence fostering reproducibility and reuse of models and simulations. Future work includes extending Kendrick to support non-compartmental models and improving its interoperability with existing complementary tools.


Assuntos
Algoritmos , Métodos Epidemiológicos , Linguagem , Modelos Teóricos , Animais , Simulação por Computador , Culicidae/fisiologia , Vetores de Doenças , Interações Hospedeiro-Parasita , Reprodutibilidade dos Testes , Processos Estocásticos
12.
Braz J Infect Dis ; 23(3): 173-181, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31228459

RESUMO

BACKGROUND: The prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil. METHODS: This was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity. RESULTS: The main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41-11.35; p < 0.001). CONCLUSIONS: This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.


Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/epidemiologia , Prisioneiros/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Métodos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Fatores Socioeconômicos
13.
Rev Saude Publica ; 53: 47, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31066825

RESUMO

OBJECTIVE: To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS: A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS: Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS: The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.


Assuntos
Inquéritos de Saúde Bucal/métodos , Métodos Epidemiológicos , Imagens de Satélites/métodos , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , População Rural , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
BMC Public Health ; 19(1): 512, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060532

RESUMO

BACKGROUND: Incidence rates and prevalence proportions are commonly used to express the populations health status. Since there are several methods used to calculate these epidemiological measures, good comparison between studies and countries is difficult. This study investigates the impact of different operational definitions of numerators and denominators on incidence rates and prevalence proportions. METHODS: Data from routine electronic health records of general practices contributing to NIVEL Primary Care Database was used. Incidence rates were calculated using different denominators (person-years at-risk, person-years and midterm population). Three different prevalence proportions were determined: 1 year period prevalence proportions, point-prevalence proportions and contact prevalence proportions. RESULTS: One year period prevalence proportions were substantially higher than point-prevalence (58.3 - 206.6%) for long-lasting diseases, and one year period prevalence proportions were higher than contact prevalence proportions (26.2 - 79.7%). For incidence rates, the use of different denominators resulted in small differences between the different calculation methods (-1.3 - 14.8%). Using person-years at-risk or a midterm population resulted in higher rates compared to using person-years. CONCLUSIONS: All different operational definitions affect incidence rates and prevalence proportions to some extent. Therefore, it is important that the terminology and methodology is well described by sources reporting these epidemiological measures. When comparing incidence rates and prevalence proportions from different sources, it is important to be aware of the operational definitions applied and their impact.


Assuntos
Métodos Epidemiológicos , Incidência , Prevalência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Reprodutibilidade dos Testes , Adulto Jovem
15.
Medicine (Baltimore) ; 98(18): e15412, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045797

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is an important public health problem in the Turkish population, that is, one of the largest migrant populations in Europe. With the introduction of cost-effective antiviral treatments in the past decade, there is a need to identify HBV-infected patients who may benefit from treatment. This study describes the design of a study to assess the HBV prevalence in the Turkish population living in Belgium. Additionally, we will determine the risk factors of HBV infection and the uptake of screening, vaccination, and antiviral treatment in this hard-to-reach Turkish population. METHODS: A longitudinal, epidemiological study will be conducted in the region Middle Limburg Belgium, where the Turkish adult population, 18 years of age and older, will be screened for hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (anti-HBc). Educational meetings concerning viral hepatitis B will be organized and there will be 3 ways to be screened for HBV: immediately after the educational meetings, at the Outpatient Hepatology Department of Ziekenhuis Oost-Limburg, and at home visits. Subsequently, participants will be asked to fill in a questionnaire regarding sociodemographic factors, migration history, risk factors for HBV infection (e.g., sharing toothbrushes, HBV-infected family member), and HBV vaccination status. Six months after screening, HBsAg-positive patients will be assessed whether they are under follow-up at the general practitioner or hepatologist. We will also gather information regarding the uptake of vaccination in nonimmunized subjects. DISCUSSION: This study will provide information about the HBV prevalence and distribution of the stages of liver disease in the Turkish population in Belgium. By determining the risk factors for HBV infection, subgroups with an increased prevalence of HBV infection can be identified. CLINICAL TRIAL NUMBER: This clinical trial is registered at clinicaltrials.gov (NCT03396458).


Assuntos
Emigrantes e Imigrantes , Hepatite B/diagnóstico , Hepatite B/etnologia , Programas de Rastreamento/organização & administração , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Bélgica/epidemiologia , Métodos Epidemiológicos , Feminino , Educação em Saúde/organização & administração , Hepatite B/tratamento farmacológico , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Turquia/etnologia , Vacinas contra Hepatite Viral/administração & dosagem , Adulto Jovem
16.
Eur J Radiol ; 115: 1-9, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084752

RESUMO

PURPOSE: To investigate the utility of whole-lesion histogram analysis from multidetector computed tomography (MDCT) for discrimination of duodenal adenocarcinoma (DAC), pancreatic ductal adenocarcinoma (PDAC) and gastrointestinal stromal tumor (GIST) around the periampullary area. MATERIALS AND METHODS: 171 patients suspicious of periampullary tumors were examined by MDCT (arterial and venous phases) and treated with surgery. A total of 74 patients were finally included in this retrospective study (26 DACs, 20 PDACs, and 28 GISTs). The interobserver agreement was evaluated by intra-class correlation coefficient (ICC) test between two radiologists. Volumetric histogram analysis based on CT Kinetics software was performed on enhanced MDCT images that recorded different histogram parameters of arterial and venous phases, including mean, median, 10th, 25th, 75th, and 90th percentiles, as well as skewness, kurtosis and entropy. The extracted histogram parameters were compared between DAC, PDAC and GIST respectively by Mann-Whitney U tests with Bonferroni corrections. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic ability of each significant parameter and the area under the curve (AUC) was calculated. RESULTS: The whole-lesion CT histogram analysis demonstrated significant differences between DAC, PDAC, and GIST with different histogram features on both arterial and venous phase scans (all P < 0.05). In the ROC analysis, the 90th percentile of venous phase demonstrated the highest AUC of 0.854 (P < 0.001) for discriminating DAC from PDAC. Excellent discriminators of periampullary tumors were noted among the histogram features, namely the 90th percentile of arterial phase, which demonstrated AUCs of 0.809 and 0.936 (P < 0.001) respectively for distinguishing DAC and PDAC from GIST. CONCLUSION: The whole-lesion CT histogram analysis could be useful for differential diagnosis of DAC, PDAC and GIST arising from the periampullary area. Further assessment is warranted to investigate the clinical role of histogram analysis based on MDCT.


Assuntos
Adenocarcinoma/patologia , Carcinoma Ductal Pancreático/patologia , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Pancreáticas/patologia , Carcinoma Ductal Pancreático/diagnóstico por imagem , Diagnóstico Diferencial , Métodos Epidemiológicos , Feminino , Neoplasias Gastrointestinais/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Variações Dependentes do Observador , Neoplasias Pancreáticas/diagnóstico por imagem
17.
Eur J Radiol ; 115: 10-15, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084753

RESUMO

PURPOSE: To explore the feasibility of predicting hematoma expansion at acute phase via a radiomics approach. METHODS: 254 cases with hypertensive intraparenchymal hematomas were retrospectively reviewed. Baseline non-contrast enhanced CT scan (NECT) were obtained on admission and compared to follow up CT to confirm the occurrence of hematoma expansion. Cases were split into training dataset with 149 cases and a test dataset with 105 cases. Radiomics features were extracted and informative features were selected by least absolute shrinkage and selection operator (LASSO) with 3-fold-cross validation. A radiomics score was then constructed with the selected features to discriminate enlarged hematomas from those that remained stable. Discriminative performance of the score was evaluated on the training and test dataset with area under the curve (AUC) and confusion matrix related metrics. RESULTS: A total of 576 radiomics features were extracted from 6 feature groups on NECT, of which 484 were stable. 5 features were selected by LASSO and based on which a radiomics score were constructed. The radiomics score achieved high discrimination ability between hematoma expansion and no-expansion with AUC of 0.892 (95% CI: 0.824-0.959) and accuracy of 0.852 in the training dataset. In the test dataset, predicting sensitivity, specificity, PPV, NPV and accuracy were 0.808, 0.835, 0.618, 0.930 and 0.820, respectively. CONCLUSIONS: Radiomics features were effective in the prediction of hematoma expansion for patients with hypertensive intraparenchymal hematomas. Our radiomics score may provide a fast and quantitative risk assessment for these patients.


Assuntos
Hemorragia Cerebral/patologia , Hipertensão/patologia , Adulto , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Métodos Epidemiológicos , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
18.
Rev Bras Epidemiol ; 22: e190026, 2019 Apr 01.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942332

RESUMO

INTRODUCTION: Dietary patterns may be more predictive of disease risk than individual nutrients or foods. OBJECTIVE: To identify dietary patterns and associated factors among adult women. METHOD: Population-based cross-sectional study with 1,128 women, aged 20 to 69 years, living in São Leopoldo, Rio Grande do Sul. Food intake was assessed with a frequency questionnaire. The principal component analysis identified dietary patterns. We estimated crude and adjusted prevalence ratios using Poisson regression with robust variance. RESULTS: Threedietary patterns - responsible for 25.8% of the total variance - were identified: healthy (fruits, vegetables, and whole foods); risk (ultra-processed foods); and Brazilian (rice and beans). The healthy pattern showed the largest percentage of explained variation (11.62%). The probability of adherence to the healthy pattern increased linearly with age and schooling and was higher among ex-smokers [prevalence ratio (PR)=1.22; confidence interval of 95% (95%CI) 1.04 - 1.42]. Younger women and those with better schooling had more chances of adhering to the risk pattern. The probability of adherence to the Brazilian pattern increased as schooling decreased and was higher among non-white women (PR = 1.29; 95%CI 1.04- 1.59). CONCLUSIONS: While adherence to healthy and risk patterns behaved differently according to women's age, it was similar regarding schooling. Socioeconomic conditions defined adherence to the Brazilian pattern.


Assuntos
Comportamento Alimentar/fisiologia , Dieta Saudável/estatística & dados numéricos , Adulto , Idoso , Brasil , Métodos Epidemiológicos , Feminino , Alimentos/classificação , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Saúde da Mulher , Adulto Jovem
19.
PLoS Negl Trop Dis ; 13(4): e0007298, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30986218

RESUMO

Only a few studies have investigated the potential of using geotagged social media data for predicting the patterns of spatio-temporal spread of vector-borne diseases. We herein demonstrated the role of human mobility in the intra-urban spread of dengue by weighting local incidence data with geo-tagged Twitter data as a proxy for human mobility across 45 neighborhoods in Yogyakarta city, Indonesia. To estimate the dengue virus importation pressure in each study neighborhood monthly, we developed an algorithm to estimate a dynamic mobility-weighted incidence index (MI), which quantifies the level of exposure to virus importation in any given neighborhood. Using a Bayesian spatio-temporal regression model, we estimated the coefficients and predictiveness of the MI index for lags up to 6 months. Specifically, we used a Poisson regression model with an unstructured spatial covariance matrix. We compared the predictability of the MI index to that of the dengue incidence rate over the preceding months in the same neighborhood (autocorrelation) and that of the mobility information alone. We based our estimates on a volume of 1·302·405 geotagged tweets (from 118·114 unique users) and monthly dengue incidence data for the 45 study neighborhoods in Yogyakarta city over the period from August 2016 to June 2018. The MI index, as a standalone variable, had the highest explanatory power for predicting dengue transmission risk in the study neighborhoods, with the greatest predictive ability at a 3-months lead time. The MI index was a better predictor of the dengue risk in a neighborhood than the recent transmission patterns in the same neighborhood, or just the mobility patterns between neighborhoods. Our results suggest that human mobility is an important driver of the spread of dengue within cities when combined with information on local circulation of the dengue virus. The geotagged Twitter data can provide important information on human mobility patterns to improve our understanding of the direction and the risk of spread of diseases, such as dengue. The proposed MI index together with traditional data sources can provide useful information for the development of more accurate and efficient early warning and response systems.


Assuntos
Dengue/epidemiologia , Transmissão de Doença Infecciosa , Métodos Epidemiológicos , Mídias Sociais , Topografia Médica , Viagem/estatística & dados numéricos , População Urbana , Dengue/transmissão , Humanos , Incidência , Indonésia/epidemiologia , Procurador , Análise Espaço-Temporal , Doença Relacionada a Viagens
20.
Rev Soc Bras Med Trop ; 52: e20180121, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30994793

RESUMO

INTRODUCTION: This study aimed to analyze the survival of septic patients and to assess prognostic factors. METHODS: Patients with sepsis, severe sepsis, and septic shock were followed up and clinical and laboratory data were collected. The sepsis-related organ failure assessment (SOFA) score was calculated. RESULTS: The overall 30-day survival rates of patients with sepsis, severe sepsis, and septic shock were 86.3%, 72.5%, and 20%, respectively. Mortality was related to old age, septic shock, coagulopathy, lactate level, and high SOFA score among other factors. CONCLUSIONS: Identification of prognostic variables may reduce sepsis-related mortality.


Assuntos
Sepse/mortalidade , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
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