A tree-based modeling approach for matched case-control studies.

Conditional logistic regression (CLR) is the indisputable standard method for the analysis of matched case-control studies. However, CLR is strongly restricted with respect to the inclusion of non-linear effects and interactions of confounding variables. A novel tree-based modeling method is proposed which accounts for this issue and provides a flexible framework allowing for a more complex confounding structure. The proposed machine learning model is fitted within the framework of CLR and, therefore, allows to account for the matched strata in the data. A simulation study demonstrates the efficacy of the method. Furthermore, for illustration the method is applied to a matched case-control study on cervical cancer.

An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019.

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45-49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65-69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.

Analysis of health claims data on vaccination coverage in older adults in Bavaria, Germany: Influenza, pneumococcus and herpes zoster.

BACKGROUND: Vaccination is essential, especially in older adults whose immune system function declines with age. The COVID-19 pandemic and its associated lockdowns temporarily disrupted routine vaccination services. We aimed to assess vaccination coverage for Influenza, Pneumococcus, and Herpes zoster among older adults in Bavaria over time and investigate potential pandemic effects on these rates. METHODS: Based on health claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB), we estimated the percentage of adults aged 60 years and older vaccinated following the German Standing Committee on Vaccinations (STIKO) recommendation for Influenza (2012-2021), Pneumococcus (2017-2021) and Herpes zoster (2019-2021), stratified by sex and 10-year age groups. Using time series regression analysis, we estimated the effect of the pandemic period (2020-2021) on quarterly Influenza and Pneumococcal vaccination rates. RESULTS: In the first year of the pandemic (2020), Influenza, Pneumococcus and Herpes zoster coverage in both sexes increased by 9.9, 8.7, and 2.5 percentage points (pp), respectively. In 2021, Influenza coverage decreased by 4.7 pp., while Pneumococcus and Herpes zoster coverage increased by 2.7 and 3.8 pp., respectively. Influenza and Pneumococcal vaccinations showed a seasonal pattern, with vaccinations occurring mainly in the fourth quarter; this pattern was distorted for Pneumococcus during the pandemic. Per the time series regression analysis, Influenza vaccination rates in the fourth quarters of 2020 and 2021 were 7.86 (95 %CI: 5.10-10.62) and 8.87 (95 %CI: 5.80-11.54) pp. higher for males and females, respectively, compared to that of the pre-pandemic period. During the pandemic, the quarterly Pneumococcal vaccination rates increased by 0.68 (95 %CI: 0.19-1.18) pp. in males and 0.80 (95 %CI: 0.30-1.30) pp. in females. CONCLUSION: The heightened increase in vaccination rates observed in 2020 may have resulted from increased vaccination awareness during the pandemic. As the pandemic effect wanes, more efforts are needed to sustain and increase these vaccination rates.

Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: A systematic review and meta-analysis.

BACKGROUND: Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences. METHODS: We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses. RESULTS: Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I2 = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I2 = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I2 = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers. CONCLUSIONS: Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.

Epidemiology of cervical cancer in elderly women: Analysis of incidence, treatment, and survival using German registry data.

BACKGROUND: Cervical cancer (CC) screening is generally recommended until age 65. The incidence of CC could be underestimated, particularly in older women, due to a lack of hysterectomy correction. Furthermore, elderly women (≥65 years) are more often diagnosed with late-stage disease and have worse outcomes than younger patients. This study aims to provide an in-depth overview of CC in Germany. METHODS: Incidence rates of CC (ICD-10 C53) were determined using data from the German Centre of Cancer Registry data (ZfKD) of six federal state registries. Incidence was corrected by using hysterectomy prevalence values from a real-world study. The distribution of treatment modalities (surgery, chemotherapy, radiation therapy) was assessed. Relative survival was calculated using the period approach (2011-2015). Survival was stratified by tumor (T) stage and histological type. RESULTS: In total, 14,528 CC cases were included, 27.6% of which occurred in elderly women. Cumulative (2001-2015) age-standardized incidence rates were 12.5 per 100,000 women without hysterectomy correction and 15.5 per 100,000 women after hysterectomy correction (+24% relative change). A lower proportion of elderly women were treated, especially in advanced tumor stages. Younger women (20-64 years) had a higher 5-year relative survival compared to elderly women: 76.7% versus 46.9%, respectively. Survival was worse with increasing stage and for glandular histological subgroups, particularly among elderly women. CONCLUSIONS: CC incidence in elderly women is underestimated and survival is lower compared to younger women in Germany. Due to the high disease burden in elderly women, screening and treatment strategies need to be improved.

The Association of Women's Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan Africa.

BACKGROUND: Women's empowerment is an important factor for HIV prevention, but the association with HIV-related indicators has never been quantified. In this study, we examined the association between women's empowerment and selected HIV-related indicators. METHODS: We used the latest Demographic and Health Surveys that included HIV testing among other biomarkers of 31 countries in sub-Saharan Africa. Empowerment was measured by the Survey-based Women's EmPowERment (SWPER) index and was compared to the HIV-related indicators: HIV status, HIV testing (ever and in the past 12 months), condom use at last high-risk sex, the ability to ask the partner to use a condom, and the ability to refuse sex. RESULTS: 208,947 women were included in the analysis, of whom 100,924 (48%) were considered highly empowered and 21,933 (10%) as lowly empowered. There was no association between empowerment and HIV status (OR = 1.12, 95% confidence interval [CI] 0.98-1.28). Highly empowered women were more likely to have ever been tested for HIV (OR = 1.67, 95% CI 1.60-1.74) but less likely to have been tested for HIV in the past 12 months (OR = 0.92, 95%CI 0.88-0.96). Highly empowered women were more commonly able to ask the partner to use a condom (OR = 1.69, 95% CI 1.63-1.75) and to refuse sex (OR = 1.78, 95%CI 1.72-1.85). CONCLUSIONS: Women's empowerment does not seem to be linked to HIV status, but it is strongly associated with a woman's ability to make decisions about their sexual behavior. Empowering women and young girls has the potential to contribute toward achieving the United Nations' goal of ending AIDS by 2030.

The Rising Incidence of Early-Onset Colorectal Cancer.

BACKGROUND: The incidence of early-onset (diagnosis before age 50) colorectal cancer (EOCRC) is increasing in some high-income countries. In this study, we examined the trends in EO-CRC incidence in Germany. METHODS: We obtained data on CRC (ICD-10 C18-C20) incidence from the Centre for Cancer Registry Data (excluding cases reported via death certificate only) and on mortality from the official cause of death statistics for 1999-2018 from registries with sufficient incidence coverage. To assess time trends for persons aged 20-49 we calculated the average annual percent changes (AAPC) and corresponding 95% confidence intervals (95% CI). The incidence analyses were stratified by sex, site (proximal colon, distal colon, rectum), age group (20-29, 30-39, and 40-49) and tumor size (T). RESULTS: EO-CRC accounted for 5.1% (9529 cases) of all colorectal cancers in the selected German regions. The EO-CRC incidence rose annually by 1.16% (95% CI: [0.51; 1.81]) in men and 1.32% [0.80; 1.84] in women. The incidence of proximal colon cancer increased in both sexes (men: AAPC = 3.26 [2.00; 4.53]; women: AAPC = 2.99 [2.17; 3.83]), while the incidence of distal colon cancer remained unchanged. CONCLUSION: The incidence of EO-CRC in Germany is rising. The reasons are probably multifactorial, reflecting the changing prevalence of early life exposure to risk and protective factors.

The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil.

OBJECTIVE: The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2. METHODS: This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes. RESULTS: We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73-95% confidence interval [95%CI] 11.07-31.69), fetal death/stillbirth (RR 1.96-95%CI 1.18-3.25), preterm birth [RR 1.18-95%CI 1.01-1.39], cesarean delivery (RR 1.07-95%CI 1.02-1.11), and cesarean delivery occurring before the onset of labor (RR 1.33-95%CI 1.23-1.44). CONCLUSION: COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.

Breast Cancer Among Female Flight Attendants and the Role of the Occupational Exposures: A Systematic Review and Meta-analysis.

OBJECTIVE: We conducted a systematic review and meta-analysis to investigate occupational exposures and their role in breast cancer (BC) risk among female flight attendants (FFAs). METHODS: We systematically searched PubMed and EMBASE and included all observational studies reporting on the outcome BC incidence among FFAs. The exposures of interest were cosmic radiation and circadian rhythm disruption. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Nine studies met the inclusion criteria, of which four were included in the meta-analysis for BC incidence (pooled standardized incidence ratio, 1.43; 95% confidence interval, 1.32 to 1.54). Three studies suggested a possible association between BC and cosmic radiation, whereas none found an association with circadian rhythm disruption. CONCLUSION: Neither exposure to cosmic radiation nor circadian rhythm disruption seems to explain the elevated risk of BC among flight attendants. Further studies reporting individual information on occupational exposures are needed.

The Joint Initiative for Teaching and Learning on Global Health Challenges and One Health experience on implementing an online collaborative course.

The "Joint Initiative for Teaching and Learning on Global Health Challenges and One Health" piloted the online course "Global Health Challenges and One Health in 2021. The present work documents this experience, lessons learned, and the future outlook of the course. A descriptive study was conducted based on the evaluations performed with the enrolled students and course coordinators. Of 30 enrolled students from graduate programs of six institutions from Brazil, Germany, Mozambique, and Kosovo, two unenrolled, and nine failed for not completing the activities. Therefore, 19 (63%) students completed the course. Some challenges identified were language and technology access barriers, difficulty scheduling group meetings due to different time zones, and high workload per credit in some institutions. Activities in groups conducted synchronously, such as debates, journal clubs, and case studies, were highlighted as those with higher impact in the learning process, having more participation of students when carried in small groups. Some students reported the establishment of research and work partnerships with other participants from partner institutions. The experience reinforces the importance of international exchange to improve collaboration between institutions and the impact of working in small interprofessional groups to develop technical, intercultural, and interdisciplinarity competencies necessary to human resources working with the One Health approach. The success of such international educational initiatives depends on overcoming barriers to implementation, which can be detected in institutional and course levels. Therefore, continuing evaluation of the course and improvements must be performed and involve all participants.

Creating a platform to enable collaborative learning in One Health: The Joint Initiative for Teaching and Learning on Global Health Challenges and One Health experience.

The "Joint Initiative for Teaching and Learning on Global Health Challenges and One Health" targets education and training in Global Health Challenges and One Health, focusing on surpassing issues that affect One Health training programs. The present work describes the planning, implementation, and challenges to develop an international educational initiative among six partner institutions from four different countries, to build a collaborative teaching and learning environment. The course applies collaborative online international learning principles and is addressed to graduate students of universities from Brazil, Germany, Mozambique, and Kosovo. A pilot curriculum was developed with modules on intercultural competence, interprofessional and collaborative practice in One Health; One Health; healthcare, surveillance, and One Health; bioethics in One Health and careers in Global Health. The course combines synchronous and asynchronous activities developed in groups by mixing students from different institutions and countries. Forty-four experts from 22 institutions of the Americas, Africa, Europe, and Asia collaborated with the course content. Some challenges to implementing the course were the different criteria to assign credits across institutions, the lack of bibliographic material across all partners, limited overlap hours and periods for synchronous activities, and short semester overlap across institutions. Despite the challenges for implementation, the entire process of planning and delivering the course involves intense international collaboration, contributing to the curriculum internationalization, benefiting all institutions involved, promoting exchange even in the challenging scenario of the pandemic of coronavirus disease 2019 (COVID-19).

[Simulation and comparison of techniques for the correction of incomplete data on age to calculate incidence rates]. / Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência.

The objective was to compare two techniques to estimate age in databases with incomplete records and analyze their application to the calculation of cancer incidence. The study used the database of the Population-Based Cancer Registry from the city of São Paulo, Brazil, containing cases of urinary tract cancer diagnosed from 1997 to 2013. Two techniques were applied to estimate age: correction factor and multiple imputation. Using binomial distribution, six databases were simulated with different proportions of incomplete data on patient's age (from 5% to 50%). The ratio between the incidence rates was calculated, using the complete database as reference, whose standardized incidence was 11.83/100,000; the other incidence rates in the databases, with at least 5% incomplete data for age, were underestimated. By applying the correction factors, the corrected rates did not differ from the standardized rates, but this technique does not allow correcting specific rates. Multiple imputation was useful for correcting the standardized and specific rates in databases with up to 30% of incomplete data, but the specific rates for individuals under 50 years of age were underestimated. Databases with 5% incomplete data or more require correction. Although the implementation of multiple imputation is complex, it proved to be superior to the correction factor. However, it should be used sparingly, since age-specific rates may remain underestimated.

O objetivo foi comparar duas técnicas para estimar idade em bancos de dados com registros incompletos e analisar sua aplicação no cálculo da incidência de câncer. Utilizou-se a base de dados do Registro de Câncer de Base Populacional do Município de São Paulo, Brasil, contendo casos diagnosticados por câncer do trato urinário, entre 1997 e 2013. Foram aplicadas duas técnicas para estimativa de idade: fator de correção e imputação múltipla. Foram simuladas, usando a distribuição binomial, seis bases de dados com diferentes proporções de dados incompletos para idade de 5% até 50%. A razão entre as incidências foi calculada tendo, como referência, a base completa, cuja incidência padronizada foi de 11,83/100 mil; as demais incidências nas bases com 5% ou mais de dados incompletos para idade apresentaram-se subestimadas. Ao aplicar o fator de correção, as taxas corrigidas não apresentaram diferenças em comparação com as padronizadas, entretanto, essa técnica não permite corrigir taxas específicas. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos, entretanto, as taxas específicas para indivíduos com menos de 50 anos apresentaram-se subestimadas. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla, apesar de complexa em sua execução, mostrou-se superior ao fator de correção. Todavia, deve ser utilizada com parcimônia, pois taxas específicas por idade podem manter-se subestimadas.

El objetivo fue comparar dos técnicas para estimar edad en bancos de datos con registros incompletos y analizar su aplicación en el cálculo de la incidencia de cáncer. Se utilizó la base de datos del Registro de Cáncer de Base Poblacional del municipio de São Paulo, Brasil, conteniendo casos diagnosticados de cáncer del tracto urinario, entre 1997 y 2013. Se aplicaron dos técnicas para la estimativa de edad: factor de corrección e imputación múltiple. Fueron simuladas, usando una distribución binomial, seis bases de datos con diferentes proporciones de datos incompletos para edad desde un 5% hasta el 50%. La razón entre las incidencias se calculó teniendo, como referencia, la base completa, cuya incidencia padronizada fue de 11,83/100.000; las demás incidencias en las bases con un 5% o más de datos incompletos en la edad se presentaron subestimadas. Al aplicar el factor de corrección, las tasas corregidas no presentaron diferencias, en comparación con las estandarizadas, sin embargo, esta técnica no permite corregir tasas específicas. La imputación múltiple fue útil en la corrección de las tasas estandarizadas y específicas en bancos con hasta un 30% de datos incompletos, no obstante, las tasas específicas para individuos con menos de 50 años se presentaron subestimadas. Bases con un 5% o más de datos incompletos necesitan una aplicación de corrección. La imputación múltiple, a pesar de ser compleja en su ejecución, se mostró superior al factor de corrección. Sin embargo, debe ser utilizada con prudencia, puesto que las tasas específicas por edad pueden seguir manteniéndose subestimadas.

Disparities in colorectal cancer mortality across Brazilian States. / Disparidades na mortalidade de câncer colorretal nos estados brasileiros.

OBJECTIVE: To analyze the trend of colorectal cancer mortality adjusted for selected indicators, according to sex, by Brazilian federative units and regions, and countrywide from 1996 to 2012. METHODS: This is a temporal time series on colorectal cancer mortality rates, using linear regression analysis, in which the independent variable was the centered year. Models were adjusted for selected indicators. RESULTS: There was an increase in standardized colorectal cancer mortality rates for males in all states and for females in 21 states. In the model adjusted for mortality rate from ill-defined causes, for gross domestic product, and for Gini coefficient, the upward trend remained statistically significant (p < 0.05) countrywide only for men, with 0.17 deaths per 100 thousand inhabitants per year (py). In the States of Piauí (0.09 and 0.20 py), Ceará (0.17 and 0.19 py) and Rio Grande do Sul (0.61 and 0.42 py), there was an increase for both men and women, respectively; only among men in the States of Paraíba (0.16 py), Espírito Santo (0.28 py), São Paulo (0.24 py) and Goiás (0.31 py); and among women in Roraima (0.41 py), Amapá (0.97 P/Y), Maranhão (0.10 py), Sergipe (0.46 P/Y), Mato Grosso do Sul (0.47 py), and the Federal District (0.69 py). CONCLUSION: The increase in colorectal cancer mortality remained significant when assessing Brazil as a whole only among men; in seven States among men, and in nine States among women, regardless of the studied indicators. These differences could be related to the possible increase in incidence and to late access to diagnosis and treatment.

OBJETIVO: Analisar a tendência da mortalidade por câncer colorretal, ajustado por indicadores selecionados, segundo sexo, para unidades federativas, regiões e Brasil, no período de 1996 a 2012. MÉTODOS: Estudo ecológico de série temporal das taxas de mortalidade por câncer colorretal, feita análise de regressão linear, sendo o ano centralizado a variável independente. Os modelos foram ajustados por indicadores selecionados. RESULTADOS: Houve aumento nas taxas de mortalidade padronizadas por câncer colorretal em todos os estados para o sexo masculino e em 21 estados para o sexo feminino. No modelo ajustado por taxa de mortalidade por causas mal definidas, produto interno bruto e coeficiente de Gini, a tendência de aumento foi significativa (p < 0,05) no Brasil, somente para os homens, com 0,17 óbitos por 100 mil habitantes ao ano (aa). Nos estados do Piauí (0,09 e 0,20 aa), Ceará (0,17 e 0,19 aa) e Rio Grande do Sul (0,61 e 0,42 aa) ocorreu aumento em homens e mulheres, respectivamente; somente em homens nos estados da Paraíba (0,16 aa), no Espírito Santo (0,28 aa), em São Paulo (0,24 aa) e Goiás (0,31 aa); e em mulheres nos estados de Roraima (0,41 aa), do Amapá (0,97 aa), Maranhão (0,10 aa), Sergipe (0,46 aa), Mato Grosso do Sul (0,47 aa) e Distrito Federal (0,69 aa). CONCLUSÃO: O aumento da taxa de mortalidade por câncer colorretal manteve-se significativo no Brasil somente entre os homens; em sete estados, entre homens; e em nove estados, entre mulheres, independentemente dos indicadores estudados. Essas diferenças podem estar relacionadas ao possível aumento da incidência e ao acesso tardio ao diagnóstico e tratamento.

Quality and completeness improvement of the Population-based Cancer Registry of São Paulo: linkage technique use. / Melhora na qualidade e completitude da base de dados do Registro de Câncer de Base Populacional do município de São Paulo: uso das técnicas de linkage.

OBJECTIVE:: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. METHODS:: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. RESULTS:: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). CONCLUSION:: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

[High prevalence of physical inactivity among adolescents living with HIV/Aids]. / Alta prevalência de sedentarismo em adolescentes que vivem com HIV/Aids.

OBJECTIVE: To assess the prevalence of physical inactivity among adolescents with HIV/AIDS, as well as associated factors. METHODS: Ninety-one adolescents (from 10 to 19 years old) with HIV/AIDS who are patients at a university follow-up service were interviewed. Anthropometric data (weight, height, and waist circumference) were measured twice; clinical information was obtained from medical records, and habitual physical activity was assessed by a questionnaire proposed by Florindo et al. The cutoff point for sedentariness was 300minutes/week. RESULTS: The prevalence of inadequate height for age, malnutrition, and overweight/obesity was 15.4%, 9.9% and 12.1%, respectively. The most common physical activities were soccer (44.4%), volleyball (14.4%) and cycling (7.8%). The median times spent with physical activity and walking/bicycling to school were 141minutes and 39minutes, respectively. Most adolescents (71.4%) were sedentary and this proportion was higher among girls (p=0.046). CONCLUSIONS: A high prevalence of physical inactivity among adolescents with HIV/AIDS was observed, similarly to the general population. Promoting physical activity among adolescents, especially among girls with HIV/AIDS, as well as monitoring it should be part of the follow-up routine of these patients.

Poor diet quality among Brazilian adolescents with HIV/AIDS.

OBJECTIVE: This study aimed to assess diet quality among adolescents with HIV/AIDS. METHOD: A cross-sectional study was conducted involving patients with HIV/AIDS treated in a referral hospital in Sao Paulo, Brazil. Eighty-eight adolescents (10-19 years of age) participated in the study. Information on disease history and use of medication were obtained from medical records. The participants responded to two 24-hour diet recalls. Diet quality was assessed by means of the Healthy Eating Index-2005 (HEI-2005) adapted to the Brazilian population. Pearson's correlation coefficients were calculated. Mean HEI-2005 scores were compared according to the independent variables using either the Student's t-test or the Mann-Whitney test. RESULTS: The mean HEI-2005 score was 51.90 (SE=0.90). The components with the lowest means were whole grains and sodium. Components with highest means were total grains and oils. No correlations were found between the independent variables and HEI score. Adolescents living in foster homes had higher means for total fruit and lower means for meat and beans in comparison to adolescents living with their families. Girls had higher means for milk and lower means for calories from solid fats, alcoholic beverages, and added sugars in comparison to boys. CONCLUSIONS: Adolescents with HIV/AIDS exhibited a similar eating pattern to that of adolescents in the general population: high consumption of added sugar, saturated fat, and sodium, and insufficient ingestion of whole grains and fruits. Special attention should be paid to the diet of adolescents with HIV/AIDS, who are at greater risk of developing cardiovascular and other chronic diseases.

Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência / Simulation and comparison of techniques for the correction of incomplete data on age to calculate incidence rates / Simulación y comparación de técnicas de corrección de datos incompletos de edad para el cálculo de tasas de incidencia

O objetivo foi comparar duas técnicas para estimar idade em bancos de dados com registros incompletos e analisar sua aplicação no cálculo da incidência de câncer. Utilizou-se a base de dados do Registro de Câncer de Base Populacional do Município de São Paulo, Brasil, contendo casos diagnosticados por câncer do trato urinário, entre 1997 e 2013. Foram aplicadas duas técnicas para estimativa de idade: fator de correção e imputação múltipla. Foram simuladas, usando a distribuição binomial, seis bases de dados com diferentes proporções de dados incompletos para idade de 5% até 50%. A razão entre as incidências foi calculada tendo, como referência, a base completa, cuja incidência padronizada foi de 11,83/100 mil; as demais incidências nas bases com 5% ou mais de dados incompletos para idade apresentaram-se subestimadas. Ao aplicar o fator de correção, as taxas corrigidas não apresentaram diferenças em comparação com as padronizadas, entretanto, essa técnica não permite corrigir taxas específicas. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos, entretanto, as taxas específicas para indivíduos com menos de 50 anos apresentaram-se subestimadas. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla, apesar de complexa em sua execução, mostrou-se superior ao fator de correção. Todavia, deve ser utilizada com parcimônia, pois taxas específicas por idade podem manter-se subestimadas.

The objective was to compare two techniques to estimate age in databases with incomplete records and analyze their application to the calculation of cancer incidence. The study used the database of the Population-Based Cancer Registry from the city of São Paulo, Brazil, containing cases of urinary tract cancer diagnosed from 1997 to 2013. Two techniques were applied to estimate age: correction factor and multiple imputation. Using binomial distribution, six databases were simulated with different proportions of incomplete data on patient's age (from 5% to 50%). The ratio between the incidence rates was calculated, using the complete database as reference, whose standardized incidence was 11.83/100,000; the other incidence rates in the databases, with at least 5% incomplete data for age, were underestimated. By applying the correction factors, the corrected rates did not differ from the standardized rates, but this technique does not allow correcting specific rates. Multiple imputation was useful for correcting the standardized and specific rates in databases with up to 30% of incomplete data, but the specific rates for individuals under 50 years of age were underestimated. Databases with 5% incomplete data or more require correction. Although the implementation of multiple imputation is complex, it proved to be superior to the correction factor. However, it should be used sparingly, since age-specific rates may remain underestimated.

El objetivo fue comparar dos técnicas para estimar edad en bancos de datos con registros incompletos y analizar su aplicación en el cálculo de la incidencia de cáncer. Se utilizó la base de datos del Registro de Cáncer de Base Poblacional del municipio de São Paulo, Brasil, conteniendo casos diagnosticados de cáncer del tracto urinario, entre 1997 y 2013. Se aplicaron dos técnicas para la estimativa de edad: factor de corrección e imputación múltiple. Fueron simuladas, usando una distribución binomial, seis bases de datos con diferentes proporciones de datos incompletos para edad desde un 5% hasta el 50%. La razón entre las incidencias se calculó teniendo, como referencia, la base completa, cuya incidencia padronizada fue de 11,83/100.000; las demás incidencias en las bases con un 5% o más de datos incompletos en la edad se presentaron subestimadas. Al aplicar el factor de corrección, las tasas corregidas no presentaron diferencias, en comparación con las estandarizadas, sin embargo, esta técnica no permite corregir tasas específicas. La imputación múltiple fue útil en la corrección de las tasas estandarizadas y específicas en bancos con hasta un 30% de datos incompletos, no obstante, las tasas específicas para individuos con menos de 50 años se presentaron subestimadas. Bases con un 5% o más de datos incompletos necesitan una aplicación de corrección. La imputación múltiple, a pesar de ser compleja en su ejecución, se mostró superior al factor de corrección. Sin embargo, debe ser utilizada con prudencia, puesto que las tasas específicas por edad pueden seguir manteniéndose subestimadas.

Disparidades na mortalidade de câncer colorretal nos estados brasileiros / Disparities in colorectal cancer mortality across Brazilian States

RESUMO: Objetivo: Analisar a tendência da mortalidade por câncer colorretal, ajustado por indicadores selecionados, segundo sexo, para unidades federativas, regiões e Brasil, no período de 1996 a 2012. Métodos: Estudo ecológico de série temporal das taxas de mortalidade por câncer colorretal, feita análise de regressão linear, sendo o ano centralizado a variável independente. Os modelos foram ajustados por indicadores selecionados. Resultados: Houve aumento nas taxas de mortalidade padronizadas por câncer colorretal em todos os estados para o sexo masculino e em 21 estados para o sexo feminino. No modelo ajustado por taxa de mortalidade por causas mal definidas, produto interno bruto e coeficiente de Gini, a tendência de aumento foi significativa (p < 0,05) no Brasil, somente para os homens, com 0,17 óbitos por 100 mil habitantes ao ano (aa). Nos estados do Piauí (0,09 e 0,20 aa), Ceará (0,17 e 0,19 aa) e Rio Grande do Sul (0,61 e 0,42 aa) ocorreu aumento em homens e mulheres, respectivamente; somente em homens nos estados da Paraíba (0,16 aa), no Espírito Santo (0,28 aa), em São Paulo (0,24 aa) e Goiás (0,31 aa); e em mulheres nos estados de Roraima (0,41 aa), do Amapá (0,97 aa), Maranhão (0,10 aa), Sergipe (0,46 aa), Mato Grosso do Sul (0,47 aa) e Distrito Federal (0,69 aa). Conclusão: O aumento da taxa de mortalidade por câncer colorretal manteve-se significativo no Brasil somente entre os homens; em sete estados, entre homens; e em nove estados, entre mulheres, independentemente dos indicadores estudados. Essas diferenças podem estar relacionadas ao possível aumento da incidência e ao acesso tardio ao diagnóstico e tratamento.

ABSTRACT: Objective: To analyze the trend of colorectal cancer mortality adjusted for selected indicators, according to sex, by Brazilian federative units and regions, and countrywide from 1996 to 2012. Methods: This is a temporal time series on colorectal cancer mortality rates, using linear regression analysis, in which the independent variable was the centered year. Models were adjusted for selected indicators. Results: There was an increase in standardized colorectal cancer mortality rates for males in all states and for females in 21 states. In the model adjusted for mortality rate from ill-defined causes, for gross domestic product, and for Gini coefficient, the upward trend remained statistically significant (p < 0.05) countrywide only for men, with 0.17 deaths per 100 thousand inhabitants per year (py). In the States of Piauí (0.09 and 0.20 py), Ceará (0.17 and 0.19 py) and Rio Grande do Sul (0.61 and 0.42 py), there was an increase for both men and women, respectively; only among men in the States of Paraíba (0.16 py), Espírito Santo (0.28 py), São Paulo (0.24 py) and Goiás (0.31 py); and among women in Roraima (0.41 py), Amapá (0.97 P/Y), Maranhão (0.10 py), Sergipe (0.46 P/Y), Mato Grosso do Sul (0.47 py), and the Federal District (0.69 py). Conclusion: The increase in colorectal cancer mortality remained significant when assessing Brazil as a whole only among men; in seven States among men, and in nine States among women, regardless of the studied indicators. These differences could be related to the possible increase in incidence and to late access to diagnosis and treatment.

Factors associated with time free of oral candidiasis in children living with HIV/AIDS, São Paulo, Brazil.

In clinical practice, recurrence of thrush is common in children living with HIV/AIDS. The aim of this study was to determine the factors associated with time spent free of oral candidiasis using survival analysis for recurrent events. A retrospective cohort study was carried out with 287 children treated between 1985 and 2009 at a reference center in the city of São Paulo, Brazil. The Prentice, Williams and Peterson model for recurrent events was used for the investigation of factors associated with the time free of oral candidiasis. The following factors were associated with the time patients were free of oral candidiasis: moderate immunodepression (HR = 2.5; p = 0.005), severe immunodepression (HR = 3.5; p < 0.001), anemia (HR = 3.3; p < 0.001), malnutrition (HR = 2.6; p = 0.004), hospitalization (HR = 2.2; p < 0.001), monotherapy (HR = 0.5; p = 0.006), dual therapy (HR = 0.3; p < 0.001) and triple therapy/highly active antiretroviral therapy (HR = 0.1; p < 0.001). The method analyzed in the present study proved useful for the investigation of recurrent events in patients living with HIV/AIDS.

Melhora na qualidade e completitude da base de dados do Registro de Câncer de Base Populacional do município de São Paulo: uso das técnicas de linkage / Quality and completeness improvement of the Population-based Cancer Registry of São Paulo: linkage technique use

RESUMO: A disponibilidade de grandes bases de dados informatizadas em saúde tornou a técnica de linkage uma alternativa para diferentes tipos de estudos, proporcionando a geração de uma base de dados mais completa e de baixo custo operacional. Objetivo: Melhorar a qualidade e a completitude dos casos incidentes de câncer por meio dos linkages probabilístico e determinístico entre o Registro de Câncer de Base Populacional de São Paulo (RCBP-SP), o banco de dados de óbitos e de Autorização e Procedimentos de Alta Complexidade. Método: Foi utilizado o banco de dados do RCBP-SP, composto de 343.306 casos de câncer incidentes no município de São Paulo entre 1997 e 2005, com idades entre 1 e 106 anos, de ambos os sexos. Para o linkage foram utilizadas três bases de dados, a saber: do Programa de Aprimoramento de Mortalidade no Município de São Paulo (PRO-AIM), da Fundação SEADE e da Autorização e Procedimentos de Alta Complexidade/Custo do Sistema de Informação Ambulatorial do Sistema Único de Saúde (APAC-SIA/SUS). Foram analisadas os coeficientes brutos de incidência (CBI) e mortalidade (CBM) e a sobrevida global pela técnica de Kaplan-Meier. Resultados: Após o linkage, verificou-se um ganho de 4,3% para a CBI e 25,8% para a CBM. Na análise de sobrevida global antes do linkage havia uma subestimação da probabilidade de estar vivo para todas as variáveis analisadas (p < 0,001). Conclusão: As técnicas de linkage contribuíram para a melhora da qualidade da informação do RCBP-SP tanto na completitude das variáveis quanto na definição do status vital do paciente, refletindo a capacidade das bases de dados, quando trabalhadas de maneira conjunta, de fornecerem subsídios para diversos tipos de estudos e informações para o planejamento de ações políticas e estratégicas.

ABSTRACT: The availability of large computerized databases on health turned the record linkage technique into an alternative for different study designs. This technique provides the creation of more complete databases, at low operational costs. Objective: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. Methods: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. Results: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). Conclusion: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.