RESUMO
BACKGROUND: Nigeria is among the top five countries in the world with the highest under-five mortality rates. In addition to the general leading causes of under-five mortality, studies have shown that disparity in sociocultural values and practices across ethnic groups in Nigeria influence child survival, thus there is a need for scientific validation. This study quantified the survival probabilities and the impact of socioeconomic and demographic factors, proximate and biological determinants, and environmental factors on the risk of under-five mortality in Nigeria. METHODS: The Kaplan-Meier survival curve, Nelson Aalen hazard curve, and components survival probabilities were estimated. The Exponential, Gamma, Log-normal, Weibull, and Cox hazard models in a Bayesian mixed effect hierarchical hazard modeling framework with spatial components were considered, and the Deviance and Watanabe Akaike information criteria were used to select the best model for inference. A [Formula: see text] level of significance was assumed throughout this work. The 2018 Nigeria Demographic and Health Survey dataset was used, and the outcome variable was the time between birth and death or birth and the date of interview for children who were alive on the day of the interview. RESULTS: Findings show that the probability of a child dying within the first two months is 0.04, and the probability of a boy child dying before attaining age five is 0.106, while a girl child is 0.094 probability. Gender, maternal education, household wealth status, source of water and toilet facility, residence, mass media, frequency of antenatal and postnatal visits, marital status, place of delivery, multiple births, who decide healthcare use, use of bednet are significant risk factors of child mortality in Nigeria. The mortality risk is high among the maternal age group below 24 and above 44years, and birth weight below 2.5Kg and above 4.5Kg. The under-five mortality risk is severe in Kebbi, Kaduna, Jigawa, Adamawa, Gombe, Kano, Kogi, Nasarawa, Plateau, and Sokoto states in Nigeria. CONCLUSION: This study accentuates the need for special attention for the first two months after childbirth as it is the age group with the highest expected mortality. A practicable way to minimize death in the early life of children is to improve maternal healthcare service, promote maternal education, encourage delivery in healthcare facilities, positive parental attitude to support multiple births, poverty alleviation programs for the less privileged, and a prioritized intervention to Northern Nigeria.
Assuntos
Prole de Múltiplos Nascimentos , Gravidez , Masculino , Criança , Humanos , Feminino , Adulto , Teorema de Bayes , Nigéria/epidemiologia , Probabilidade , EscolaridadeRESUMO
Long-term survivor models have been extensively used for modelling time-to-event data with a significant proportion of patients who do not experience poor outcome. In this paper, we propose a new long-term survivor hazard model, which accommodates comprehensive families of cure rate models as particular cases, including modified Weibull, exponentiated Weibull, Weibull, exponential and Rayleigh distribution, among others. The maximum likelihood estimation procedure is presented. A simulation study evaluates bias and mean square error of the considered estimation procedure as well as the coverage probabilities of the parameters asymptotic and bootstrap confidence intervals. A real Brazilian dataset on breast cancer illustrates the methodology. From the practical point of view, under our modelling, we provide a parameter that works as a metric to quantify and compare the risk between different stages of the disease. We emphasize that, we developed an online platform for oncologists to calculate the probability of survival of patients diagnosed with breast cancer according to the stage of the disease in real time.
Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Estadiamento de Neoplasias , Análise de Sobrevida , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Funções Verossimilhança , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Adulto JovemRESUMO
The objectives of this study were to evaluate the reproductive and productive performance of dairy cows with and without puerperal metritis and to evaluate the effectiveness of using a long-acting ceftiofur preparation. Dairy cows in one dairy farm, calving from July 2009 to January 2010, were examined between 3 and 14 days postpartum and classified on the basis of vaginal discharge into three groups: cows with normal discharge (control; C); cows with a bloody mucus purulent or pathologic nonfetid discharge (PnFD), and cows with bloody mucopurulent or purulent fetid discharge (PFD). Cows in C and PnFD groups were not treated, whereas those in the PFD group were randomly allocated to receive 2.2 mg/kg of ceftiofur subcutaneously behind the ear (PFD-T) or remain untreated (PFD-No T). From the 640 cows examined, 58.2% formed the C group, 13.4% formed the PnFD group, and 28.4% formed the PFD group. Survival curves differed between cows in the C group and PFD-No T group (P = 0.0013) and between PFD-No T versus PFD-T group (P = 0.0006). Survival curves of PnFD were intermediate and did not differ from those in the C group (P = 0.2) and PFD-T group (P = 0.1) but tended to be different from the PFD-No T group (P = 0.056). The postpartum interval to achieve a 25% pregnancy rate was 72 days for cows in the C group, 73 days for the PFD-T group, 83 days for PnFD group, and 95 days for the PFD-No T group. The chance of pregnancy in a cow in the C group was 1.98 times higher (95% confidence interval = 1.33, 3.08) and in cows in the PFD-T group was 2.16 times higher (95% confidence interval = 1.37, 3.50) than that in the PFD-No T group. Finally, the chance of pregnancy in cows in the PnFD group tended to be higher (P = 0.08) than that in the PFD-No T group but did not differ from the other two groups. Cumulative 305-day milk production was higher (P < 0.0001) in C group than those with vaginal discharge, regardless of fetidness and regardless of treatment. It is concluded that puerperal metritis affects the reproductive and productive performance of dairy cows and the treatment with ceftiofur was effective in reducing the adverse effects on reproductive performance but not on milk production.
Assuntos
Doenças dos Bovinos/fisiopatologia , Bovinos , Endometrite/fisiopatologia , Lactação/fisiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Infecção Puerperal/fisiopatologia , Reprodução/fisiologia , Animais , Argentina/epidemiologia , Doenças dos Bovinos/epidemiologia , Indústria de Laticínios/estatística & dados numéricos , Endometrite/complicações , Endometrite/epidemiologia , Feminino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/veterinária , Taxa de Gravidez , Infecção Puerperal/epidemiologia , Infecção Puerperal/veterinária , Descarga Vaginal/complicações , Descarga Vaginal/epidemiologia , Descarga Vaginal/fisiopatologia , Descarga Vaginal/veterináriaRESUMO
Sequentially randomized designs are commonly used in biomedical research, particularly in clinical trials, to assess and compare the effects of different treatment regimes. In such designs, eligible patients are first randomized to one of the initial therapies, then patients with some intermediate response (e.g. without progressive diseases) are randomized to one of the maintenance therapies. The goal is to evaluate dynamic treatment regimes consisting of an initial therapy, the intermediate response, and a maintenance therapy. In this article, we demonstrate the use of pattern-mixture model (commonly used for analyzing missing data) for estimating the effects of treatment regimes based on familiar survival analysis techniques such as Nelson-Aalen and parametric models. Moreover, we demonstrate how to use estimates from pattern-mixture models to test for the differences across treatment regimes in a weighted log-rank setting. We investigate the properties of the proposed estimators and test in a Monte Carlo simulation study. Finally we demonstrate the methods using the long-term survival data from the high risk neuroblastoma study.
RESUMO
The growth of Protestantism in Brazil has been associated with changes in mortality and health-related outcomes. Recent research has suggested that affiliation with Protestant churches may positively influence their members' well being by: 1) providing moral directives, 2) creating formal or informal sanctions, and 3) promoting social networks and support. This article uses data from the 1996 and 2006 Brazilian Demographic Health Surveys (DHS) and Cox's proportional hazard models to examine the relationship between infant mortality and mothers' religious involvement. Unadjusted results show that differences in the hazard ratios of infant mortality by mothers' religious involvement are considerable and statistically significant. When one controls demographic and socioeconomic variables in the 1996 DHS, the baseline relationship disappears, supporting the hypothesis of selectivity. Results using the 2006 DHS are somewhat different and suggest that the association between religious involvement and infant mortality was stronger in Brazil in 2006 than in 1996. This research should encourage future studies on religious involvement and health-related outcomes in Brazil. This topic deserves further consideration from Brazilian demographers not simply because this country has undergone enormous changes in its religious landscape over recent decades, but also because religion can affect believers' lifestyles and behaviors, and this can indirectly influence their health and well-being.
O crescimento do Protestantismo no Brasil tem sido associado a mudanças em variáveis de mortalidade e saúde. Estudos recentes sugerem que a afiliação com igrejas Protestantes pode positivamente influenciar o bem-estar de seus membros a partir: 1) do ensinamento de diretrizes morais; 2) da criação de sanções formais e informais; e 3) da promoção de redes sociais e de suporte. Este trabalho utiliza dados da Pesquisa Nacional de Demografia e Saúde (PNDS) de 1996 e 2006 e modelos de risco proporcional de Cox para examinar a associação entre mortalidade infantil e envolvimento religioso da mãe. Resultados bivariados mostram que as diferenças nas razões de risco da mortalidade infantil por envolvimento religioso materno são consideráveis e estatisticamente significativas. Ao controlar por variáveis demográficas e socioeconômicas na amostra de 1996, esta associação inicial desaparece, o que corrobora a hipótese de seletividade. Resultados usando a PNDS de 2006 mostram, no entanto, que os diferenciais na mortalidade infantil por participação em cultos religiosos ou missas ainda são observados no modelo multivariado. Tal constatação sugere que a associação entre envolvimento religioso materno e mortalidade infantil no Brasil é mais forte em 2006 do que era em 1996. Este trabalho deve encorajar novos estudos sobre a relação entre religião e variáveis de saúde no Brasil. Este tema merece maior consideração dos demógrafos no Brasil não somente porque este país tem passado por profundas mudanças religiosas, mas também porque a religião pode afetar o comportamento e o estilo de vida de seus fiéis, o que, por sua vez, pode influenciar o bem-estar e a saúde destes indivíduos.
El crecimiento del protestantismo en Brasil ha sido asociado a cambios en variables de mortalidad y salud. Estudios recientes sugieren que la afiliación a iglesias protestantes puede influenciar positivamente en el bienestar de sus miembros por: 1) la enseñanza de directrices morales; 2) la creación de sanciones formales e informales; y 3) la promoción de redes sociales y de apoyo. Este trabajo utiliza datos de la Investigación Nacional de Demografía y Salud (PNDS) de 1996 y 2006 y modelos de riesgo proporcional de Cox para examinar la asociación entre mortalidad infantil e implicación religiosa de la madre. Resultados bivariados muestran que las diferencias en las razones de riesgo de la mortalidad infantil por implicación religiosa materna son considerables y estadísticamente significativas. Al controlar por variables demográficas y socioeconómicas en la muestra de 1996, esta asociación inicial desaparece, lo que corrobora la hipótesis de selectividad. Resultados usando la PNDS de 2006 muestran, no obstante, que los diferenciales en la mortalidad infantil por participación en cultos religiosos o misas se observan incluso en el modelo multivariado. Tal constatación sugiere que la asociación entre implicación religiosa materna y mortalidad infantil en Brasil es más fuerte en 2006 de lo que era en 1996. Este trabajo debe animar nuevos estudios sobre la relación entre religión y variables de salud en Brasil. Este tema merece mayor consideración de los demógrafos en Brasil, no solamente porque este país ha pasado por profundos cambios religiosos, sino también porque la religión puede afectar el comportamiento y el estilo de vida de sus fieles, lo que a su vez, puede influenciar en el bienestar y la salud de estos individuos.