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BACKGROUND: Most previous studies of frailty trajectories in older adults focus on the average trajectory and ignore death. Longitudinal quantile analysis of frailty trajectories permits the definition of reference curves, and the application of mortal cohort inference provides more realistic estimates than models that ignore death. METHODS: Using data from individuals aged 65 or older (nâ =â 25 446) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2004 to 2020, we derived repeated values of the Frailty Index (FI) based on the accumulation of health deficits. We applied weighted Generalized Estimating Equations to estimate the quantiles of the FI trajectory, adjusting for sample attrition due to death, sex, education, and cohort. RESULTS: The FI quantiles increased with age and progressed faster for those with the highest level of frailty (ß^a0.9 = 0.0229, pâ <â .001; ß^a0.5 = 0.0067, pâ <â .001; H0: ßa0.5=ßa0.9, pâ <â .001). Education was consistently associated with a slower progression of the FI in all quantiles (ß^ae0.1 = -0.0001, pâ <â .001; ß^ae0.5 =-0.0004, pâ <â .001; ß^ae0.9 = -0.0003, pâ <â .001) but sex differences varied across the quantiles. Women with the highest level of frailty showed a slower progression of the FI than men when considering death. Finally, no cohort effects were observed for the FI progression. CONCLUSIONS: Quantile FI trajectories varied by age, sex, education, and cohort. These differences could inform the practice of interventions aimed at older adults with the highest level of frailty.
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Fragilidade , Idoso , Humanos , Feminino , Masculino , Idoso Fragilizado , Avaliação Geriátrica , Estudos Longitudinais , EnvelhecimentoRESUMO
Epilepsy is a chronic neurological disease characterized by the presence of spontaneous seizures, with a higher incidence in the pediatric population. Anti-seizure medication (ASM) may produce adverse drug reactions (ADRs) with an elevated frequency and a high severity. Thus, the objective of the present study was to analyze, through intensive pharmacovigilance over 112 months, the ADRs produced by valproic acid (VPA), oxcarbazepine (OXC), phenytoin (PHT), and levetiracetam (LEV), among others, administered to monotherapy or polytherapy for Mexican hospitalized pediatric epilepsy patients. A total of 1034 patients were interviewed; 315 met the inclusion criteria, 211 patients presented ADRs, and 104 did not. A total of 548 ASM-ADRs were identified, and VPA, LEV, and PHT were the main culprit drugs. The most frequent ADRs were drowsiness, irritability, and thrombocytopenia, and the main systems affected were hematologic, nervous, and dermatologic. LEV and OXC caused more nonsevere ADRs, and PHT caused more severe ADRs. The risk analysis showed an association between belonging to the younger groups and polytherapy with ADR presence and between polytherapy and malnutrition with severe ADRs. In addition, most of the severe ADRs were preventable, and most of the nonsevere ADRs were nonpreventable.
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In many situations, it is common to have more than one observation per experimental unit, thus generating the experiments with repeated measures. In the modeling of such experiments, it is necessary to consider and model the intra-unit dependency structure. In the literature, there are several proposals to model positive continuous data with repeated measures. In this paper, we propose one more with the generalization of the beta prime regression model. We consider the possibility of dependence between observations of the same unit. Residuals and diagnostic tools also are discussed. To evaluate the finite-sample performance of the estimators, using different correlation matrices and distributions, we conducted a Monte Carlo simulation study. The methodology proposed is illustrated with an analysis of a real data set. Finally, we create an R package for easy access to publicly available the methodology described in this paper.
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In neuroscience research, longitudinal data are often analysed using analysis of variance (ANOVA) and multivariate analysis of variance (MANOVA) for repeated measures (rmANOVA/rmMANOVA). However, these analyses have special requirements: The variances of the differences between all possible pairs of within-subject conditions (i.e., levels of the independent variable) must be equal. They are also limited to fixed repeated time intervals and are sensitive to missing data. In contrast, other models, such as the generalized estimating equations (GEE) and the generalized linear mixed models (GLMM), suggest another way to think about the data and the studied phenomenon. Instead of forcing the data into the ANOVAs assumptions, it is possible to design a flexible/personalized model according to the nature of the dependent variable. We discuss some advantages of GEE and GLMM as alternatives to rmANOVA and rmMANOVA in neuroscience research, including the possibility of using different distributions for the parameters of the dependent variable, a better approach for different time length points, and better adjustment to missing data. We illustrate these advantages by showing a comparison between rmANOVA and GEE in a real example and providing the data and a tutorial code to reproduce these analyses in R. We conclude that GEE and GLMM may provide more reliable results when compared to rmANOVA and rmMANOVA in neuroscience research, especially in small sample sizes with unbalanced longitudinal designs with or without missing data.
Assuntos
Modelos Estatísticos , Neurociências , Análise de Variância , Projetos de Pesquisa , Modelos Lineares , Estudos LongitudinaisRESUMO
The prevalence of obesity and overweight in Mexican children and adolescents is high (greater than 30%) and lifestyle behaviors are far from achieving health recommendations. Salud Escolar is a complex cross-sectoral multi-level policy-based program in Mexico aiming to support schoolchildren healthy behaviors. We describe the rationale, design and methods for the comprehensive evaluation of Salud Escolar during its first phase of implementation. Using a mixed-methods approach and the logic model of Salud Escolar as a guide, a comprehensive evaluation involving 3 types of evaluations was designed: 1) A design evaluation before program implementation, to determine the consistency between the design of Salud Escolar and the problem to be addressed (i.e., childhood obesity), 2) An implementation evaluation to assess potential execution bottlenecks, and 3) An outcomes evaluation, to measure short-term (i.e., knowledge, attitudes and practices related to healthy eating, drinking plain water and doing regular physical activity) and intermediate outcomes (i.e., fruit and vegetable intake, water consumption and daily moderate to vigorous physical activity). This evaluation will provide essential knowledge about program design and implementation processes, which are vital for drawing robust conclusions about the effectiveness of the program. Results and lessons learned from this comprehensive evaluation will provide evidence to improve Salud Escolar program and facilitate its upscaling process and may provide relevant information for school-based programs in other places sharing socio-contextual conditions.
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OBJECTIVE: To test the association of material deprivation and the utilization of vision care services for young children. STUDY DESIGN: We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician. RESULTS: Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas. CONCLUSIONS: Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.
Assuntos
Utilização de Instalações e Serviços/economia , Acessibilidade aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Classe Social , Transtornos da Visão/diagnóstico , Testes Visuais/economia , Criança , Pré-Escolar , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Lactente , Estudos Longitudinais , Masculino , Ontário , Testes Visuais/estatística & dados numéricosRESUMO
In a granulometric analysis of coffee beans with different categories of defects, the data can be organized in contingency tables, and when considering the discrimination by harvest, they may have a structure that suggest a more complex model, by means of the counting of defective coffee beans compared to different crops interacting with the classification of defects and percentages of sieve grains, which characterizes a block design with multivariate responses. However, due to the techniques based on the analysis of variance, considering the uniform correlation structure for all plots, it becomes feasible to propose a model that allows contemplating different structures between the plots, associating the effects of the crops to the defects in the granulometric procedure applied to the coffee beans. Thus, the hypothesis of incorporating the effects of crops associated with defects arises using the biplot multivariate technique. This work aims to propose the use of corrected biplots by predictions obtained trhough the fit to the Generalized Linear Model in the coffee grain size classification, broken down by components of the effect of the harvests. In conclusion, the use of GEE models with the corrected biplot technique by the predictions is feasible for application to be applied to the granulometric analysis of defective coffee beans, presenting discrimination regarding the effects of harvests.
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Café , Produtos Agrícolas , Análise MultivariadaRESUMO
OBJECTIVE: To determine the natural history of pulmonary function for survivors of congenital diaphragmatic hernia (CDH). STUDY DESIGN: This was a retrospective cohort study of survivors of CDH born during 1991-2016 and followed at our institution. A generalized linear model was fitted to assess the longitudinal trends of ventilation (V), perfusion (Q), and V/Q mismatch. The association between V/Q ratio and body mass index percentile as well as functional status was also assessed with a generalized linear model. RESULTS: During the study period, 212 patients had at least one V/Q study. The average ipsilateral V/Q of the cohort increased over time (P < .01), an effect driven by progressive reduction in relative perfusion (P = .012). A higher V/Q ratio was correlated with lower body mass index percentile (P < .001) and higher probability of poor functional status (New York Heart Association class III or IV) (P = .045). CONCLUSIONS: In this cohort of survivors of CDH with more severe disease characteristics, V/Q mismatch worsens over time, primarily because of progressive perfusion deficit of the ipsilateral side. V/Q scans may be useful in identifying patients with CDH who are at risk for poor growth and functional status.
Assuntos
Hérnias Diafragmáticas Congênitas/fisiopatologia , Pulmão/fisiopatologia , Relação Ventilação-Perfusão , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
Essential oils from six species of aromatic plants collected in the Catamarca Province of Argentina were evaluated for their chemical composition and repellent and insecticidal activities against beetles of the genus Carpophilus (Coleoptera: Nitidulidae) and Oryzaephilus (Coleoptera: Silvanidae) that infest the local walnut production. Experimental data were analyzed using generalized estimating equations, with normal distribution and the identity link function. From the spectral information from the tested essential oils, we worked their molecular modeling as mixtures by developing mixture descriptors ( Dmix) that combined the molecular descriptor of each component in the mixture ( d i) and its relative concentration ( x i), i.e., Dmix = f( d i, x i). The application of chemoinformatic approaches determined that a combination of mixture descriptors related to molecular size, branchedness, charge distribution, and electronegativity were useful to explain the bioactivity profile against Carpophilus spp. and Oryzaephilus spp. The reported models were rigorously validated using stringent statistical parameters and essential oils reported with repellent activity against other beetle species from the Nitidulidae and Silvanidae families. This model confirmed each essential oil as a repellent with a comparable performance to the experimental reports.
Assuntos
Besouros/efeitos dos fármacos , Repelentes de Insetos/química , Repelentes de Insetos/farmacologia , Juglans/parasitologia , Óleos Voláteis/química , Óleos Voláteis/farmacologia , Doenças das Plantas/parasitologia , Animais , Argentina , Besouros/fisiologia , Nozes/parasitologia , Doenças das Plantas/prevenção & controle , Óleos de Plantas/química , Óleos de Plantas/farmacologia , Relação Quantitativa Estrutura-AtividadeRESUMO
Experiments where the response is a categorical variable are usually carried out in many fields such as agriculture. In addition, in some situations this response has three or more levels without an order between them characterizing a multinomial (nominal) response. Statistical models for scenarios where the observations of a nominal response can be considered independent have an extensive literature, such as the baseline-category logit models. However, situations where this assumption is violated (as in longitudinal studies) require specific models that take into consideration the dependence between observations. In this paper, a fairly new extension of the generalized estimating equations is applied to analyze an experiment carried out to investigate the type of vegetation observed in an elephant grass pasture, according to some management conditions over time. This extension uses local odds ratios to explain the dependence among the categories of the outcome over the repeated measurements. Two different structures were compared to describe this dependence, and the Wald test was used to select the significant variables. Further, we built confidence intervals for the predicted probabilities of occurrence of each category and assessed the results comparing observed/predicted values and using the diagnostic analysis. The results allowed to conclude that there are various significant effects for treatments and for time. The structure of local odds ratio also proved as a good way to describe the dependence between categorical responses over time.(AU)
Assuntos
Estatísticas Ambientais/métodos , Razão de Chances , Geografia , Pennisetum/crescimento & desenvolvimento , 24444 , Modelos Estatísticos , Dispersão VegetalRESUMO
Experiments where the response is a categorical variable are usually carried out in many fields such as agriculture. In addition, in some situations this response has three or more levels without an order between them characterizing a multinomial (nominal) response. Statistical models for scenarios where the observations of a nominal response can be considered independent have an extensive literature, such as the baseline-category logit models. However, situations where this assumption is violated (as in longitudinal studies) require specific models that take into consideration the dependence between observations. In this paper, a fairly new extension of the generalized estimating equations is applied to analyze an experiment carried out to investigate the type of vegetation observed in an elephant grass pasture, according to some management conditions over time. This extension uses local odds ratios to explain the dependence among the categories of the outcome over the repeated measurements. Two different structures were compared to describe this dependence, and the Wald test was used to select the significant variables. Further, we built confidence intervals for the predicted probabilities of occurrence of each category and assessed the results comparing observed/predicted values and using the diagnostic analysis. The results allowed to conclude that there are various significant effects for treatments and for time. The structure of local odds ratio also proved as a good way to describe the dependence between categorical responses over time.
Assuntos
24444 , Estatísticas Ambientais/métodos , Geografia , Pennisetum/crescimento & desenvolvimento , Razão de Chances , Dispersão Vegetal , Modelos EstatísticosRESUMO
This study aimed to evaluate the association between diarrhea and risk factors potentially related to diarrhea incidence, such as Cryptosporidium, Giardia, Eimeria and nematode infection, animal age, failure to transfer passive immunity, type of fertilization (artificial insemination - AI, in vitro production of embryos - IVP and natural breeding), mother (heifer/cow) and birth weight of heifer calves reared in individual outdoor hutches on a dairy farm. The database used in the present study refers to a weekly survey of a cohort of 118 heifer calves from birth to 100 days of age. A logistic generalized additive model (GAM) was fit to evaluate the functional relationship between the risk of diarrhea occurrence and birth weight. For analysis purposes, the database was divided into calves up to 30 days old and calves 31 to 100 days old. Bivariate and multivariate analyses were performed using logistic regression models via generalized estimating equations. All variables were included in the models and were removed oneby-one according to Wald statistics to obtain the final model. The relative risks (RR) and their respective 90% confidence intervals were estimated. The final model for calves up to 30 days old showed that IVP [RR=0.33 (90% CI 0.14; 0.75)] is a protective factor and that Cryptosporidium spp. infection [RR=1.95 (90% CI 1.22; 3.12)] is a risk factor. Although not statistically significant [RR=1.46 (90% CI 0.98; 2.18)], failure to transfer passive immunity increases the risk of diarrhea. The final model for calves 31 - 100 days old showed that IVP [RR=0.50 (90% IC 0.28; 0.89)] and birth weight ≥ 40 kg [RR=0.65 (90% CI 0.47; 0.89)] are protective factors.
Este trabalho teve como objetivo estudar a associação entre a diarreia e os possíveis fatores de risco para sua incidência, tais como: infecção por Cryptosporidium, Giardia, Eimeria e nematóides, idade, falha na transferência de imunidade passiva, tipo de fertilização (Inseminação artificial - IA, Produção in vitro de embriões PIVE e monta natural), mãe (novilha/vaca) e peso ao nascer, em bezerras criadas sob sistema de abrigo individual em piquete, em uma fazenda de produção leiteira. O banco de dados utilizado refere-se ao acompanhamento semanal de uma coorte de 118 bezerras do nascimento aos cem dias de idade. Um modelo logístico aditivo generalizado (GAM) foi ajustado para avaliar a relação funcional entre o risco de ser acometido por diarreia e o peso ao nascer. Para fins de análise, o banco de dados foi dividido em bezerras até 30 dias de idade e de 31 a 100 dias de idade. Análises bivariadas e multivariadas foram realizadas utilizando-se os modelos de regressão logística via equações estimadas generalizadas. Todas as variáveis foram incluídas nos modelos, sendo retiradas uma a uma, segundo a estatística de Wald, até a obtenção do modelo final. Foram estimados os riscos relativos (RR) e seus respectivos intervalos com 90% de confiança. O modelo final para bezerras com até 30 dias de idade mostrou evidências de que o tipo de fertilização PIVE [RR= 0,33 (IC 90% 0,14; 0,75)] é um fator de proteção e a infecção por Cryptosporidium spp. [RR= 1,95 (IC 90% 1,22; 3,12)] um fator de risco. Embora, sem significância estatística [RR=1,46 (IC 90% 0,98; 2,18)], a falha na transferência de imunidade passiva aumenta o risco de diarreia. O modelo final, para bezerras de 31 a 100 dias de idade, mostrou evidências de que PIVE [RR=0,50 (IC 90% 0,28; 0,89)] e peso ao nascer ≥ 40 kg [RR= 0,65 (IC 90% 0,47; 0,89)] são fatores de proteção. Nesta faixa etária, a infecção por Cryptosporidium spp não tem significância estatística [RR= 1,25 (IC 90% 0,95; 1,64)].
Assuntos
Feminino , Animais , Bovinos , Análise de Regressão , Diarreia/diagnóstico , Diarreia/veterinária , Fatores de Risco , BovinosRESUMO
This study aimed to evaluate the association between diarrhea and risk factors potentially related to diarrhea incidence, such as Cryptosporidium, Giardia, Eimeria and nematode infection, animal age, failure to transfer passive immunity, type of fertilization (artificial insemination - AI, in vitro production of embryos - IVP and natural breeding), mother (heifer/cow) and birth weight of heifer calves reared in individual outdoor hutches on a dairy farm. The database used in the present study refers to a weekly survey of a cohort of 118 heifer calves from birth to 100 days of age. A logistic generalized additive model (GAM) was fit to evaluate the functional relationship between the risk of diarrhea occurrence and birth weight. For analysis purposes, the database was divided into calves up to 30 days old and calves 31 to 100 days old. Bivariate and multivariate analyses were performed using logistic regression models via generalized estimating equations. All variables were included in the models and were removed oneby-one according to Wald statistics to obtain the final model. The relative risks (RR) and their respective 90% confidence intervals were estimated. The final model for calves up to 30 days old showed that IVP [RR=0.33 (90% CI 0.14; 0.75)] is a protective factor and that Cryptosporidium spp. infection [RR=1.95 (90% CI 1.22; 3.12)] is a risk factor. Although not statistically significant [RR=1.46 (90% CI 0.98; 2.18)], failure to transfer passive immunity increases the risk of diarrhea. The final model for calves 31 - 100 days old showed that IVP [RR=0.50 (90% IC 0.28; 0.89)] and birth weight ≥ 40 kg [RR=0.65 (90% CI 0.47; 0.89)] are protective factors.(AU)
Este trabalho teve como objetivo estudar a associação entre a diarreia e os possíveis fatores de risco para sua incidência, tais como: infecção por Cryptosporidium, Giardia, Eimeria e nematóides, idade, falha na transferência de imunidade passiva, tipo de fertilização (Inseminação artificial - IA, Produção in vitro de embriões PIVE e monta natural), mãe (novilha/vaca) e peso ao nascer, em bezerras criadas sob sistema de abrigo individual em piquete, em uma fazenda de produção leiteira. O banco de dados utilizado refere-se ao acompanhamento semanal de uma coorte de 118 bezerras do nascimento aos cem dias de idade. Um modelo logístico aditivo generalizado (GAM) foi ajustado para avaliar a relação funcional entre o risco de ser acometido por diarreia e o peso ao nascer. Para fins de análise, o banco de dados foi dividido em bezerras até 30 dias de idade e de 31 a 100 dias de idade. Análises bivariadas e multivariadas foram realizadas utilizando-se os modelos de regressão logística via equações estimadas generalizadas. Todas as variáveis foram incluídas nos modelos, sendo retiradas uma a uma, segundo a estatística de Wald, até a obtenção do modelo final. Foram estimados os riscos relativos (RR) e seus respectivos intervalos com 90% de confiança. O modelo final para bezerras com até 30 dias de idade mostrou evidências de que o tipo de fertilização PIVE [RR= 0,33 (IC 90% 0,14; 0,75)] é um fator de proteção e a infecção por Cryptosporidium spp. [RR= 1,95 (IC 90% 1,22; 3,12)] um fator de risco. Embora, sem significância estatística [RR=1,46 (IC 90% 0,98; 2,18)], a falha na transferência de imunidade passiva aumenta o risco de diarreia. O modelo final, para bezerras de 31 a 100 dias de idade, mostrou evidências de que PIVE [RR=0,50 (IC 90% 0,28; 0,89)] e peso ao nascer ≥ 40 kg [RR= 0,65 (IC 90% 0,47; 0,89)] são fatores de proteção. Nesta faixa etária, a infecção por Cryptosporidium spp não tem significância estatística [RR= 1,25 (IC 90% 0,95; 1,64)].(AU)
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Animais , Feminino , Bovinos , Fatores de Risco , Diarreia/diagnóstico , Diarreia/veterinária , Análise de Regressão , BovinosRESUMO
Prenatal exposure to neurotoxicants such as lead (Pb) may cause stable changes in the DNA methylation (5mC) profile of the fetal genome. However, few studies have examined its effect on the DNA de-methylation pathway, specifically the dynamic changes of the 5-hydroxymethylcytosine (5hmC) profile. Therefore, in this study, we investigate the relationship between Pb exposure and 5mC and 5hmC modifications during early development. To study the changes in the 5hmC profile, we use a novel modification of the Infinium™ HumanMethylation450 assay (Illumina, Inc.), which we named HMeDIP-450K assay, in an in vitro human embryonic stem cell model of Pb exposure. We model Pb exposure-associated 5hmC changes as clusters of correlated, adjacent CpG sites, which are co-responding to Pb. We further extend our study to look at Pb-dependent changes in high density 5hmC regions in umbilical cord blood DNA from 48 mother-infant pairs from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. For our study, we randomly selected umbilical cord blood from 24 male and 24 female children from the 1st and 4th quartiles of Pb levels. Our data show that Pb-associated changes in the 5hmC and 5mC profiles can be divided into sex-dependent and sex-independent categories. Interestingly, differential 5mC sites are better markers of Pb-associated sex-dependent changes compared to differential 5hmC sites. In this study we identified several 5hmC and 5mC genomic loci, which we believe might have some potential as early biomarkers of prenatal Pb exposure.
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Ilhas de CpG/efeitos dos fármacos , Citosina/análogos & derivados , Exposição Ambiental/efeitos adversos , Células-Tronco Embrionárias Humanas/efeitos dos fármacos , Chumbo/efeitos adversos , Cordão Umbilical/efeitos dos fármacos , 5-Metilcitosina/análogos & derivados , Linhagem Celular , Citosina/química , Citosina/metabolismo , Metilação de DNA/efeitos dos fármacos , Sangue Fetal/efeitos dos fármacos , Humanos , México , Análise de Sequência de DNA , Fatores SexuaisRESUMO
This paper presents a modeling effort for developing safety performance models (SPM) for urban intersections for three major Brazilian cities. The proposed methodology for calibrating SPM has been divided into the following steps: defining the safety study objective, choosing predictive variables and sample size, data acquisition, defining model expression and model parameters and model evaluation. Among the predictive variables explored in the calibration phase were exposure variables (AADT), number of lanes, number of approaches and central median status. SPMs were obtained for three cities: Fortaleza, Belo Horizonte and Brasília. The SPM developed for signalized intersections in Fortaleza and Belo Horizonte had the same structure and the most significant independent variables, which were AADT entering the intersection and number of lanes, and in addition, the coefficient of the best models were in the same range of values. For Brasília, because of the sample size, the signalized and unsignalized intersections were grouped, and the AADT was split in minor and major approaches, which were the most significant variables. This paper also evaluated SPM transferability to other jurisdiction. The SPM for signalized intersections from Fortaleza and Belo Horizonte have been recalibrated (in terms of the Cx) to the city of Porto Alegre. The models were adjusted following the Highway Safety Manual (HSM) calibration procedure and yielded Cx of 0.65 and 2.06 for Fortaleza and Belo Horizonte SPM respectively. This paper showed the experience and future challenges toward the initiatives on development of SPMs in Brazil, that can serve as a guide for other countries that are in the same stage in this subject.
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Acidentes de Trânsito/prevenção & controle , Cidades , Planejamento Ambiental , Modelos Estatísticos , Segurança/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Brasil , Calibragem , HumanosRESUMO
Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.
Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtornos Dismórficos Corporais/psicologia , Clomipramina/uso terapêutico , Fluoxetina/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Adulto , Antidepressivos de Segunda Geração/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Antipsicóticos/efeitos adversos , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/epidemiologia , Brasil , Clomipramina/efeitos adversos , Comorbidade , Quimioterapia Combinada , Feminino , Fluoxetina/efeitos adversos , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Estudos Prospectivos , Fumarato de Quetiapina/efeitos adversos , Fatores de Risco , Resultado do TratamentoRESUMO
Prenatal exposure to bisphenol A (BPA) may be associated with adverse health effects in the developing fetus; however, little is known about predictors of BPA exposure during pregnancy. We examined BPA exposure in 491 pregnant women from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort and explored the role of living in the United States on significant dietary predictors of BPA exposure. Women provided urine samples up to two times during pregnancy (n=866 total samples). We computed the intraclass correlation coefficient (ICC) to evaluate variability in concentrations between collections and used generalized estimating equation (GEE) models to assess predictors of exposure. Geometric mean (GSD) BPA concentrations were 0.9 (2.8)µg/L and 1.0 (2.6)µg/L at the first and second prenatal visits, respectively. We observed greater within- than between-woman variability in urinary BPA concentrations (ICC=0.22). GEE models suggest that women who lived in the United States their entire life had 38% (CI: -0.1, 89.3) higher urinary BPA concentrations compared with other immigrant women. Additionally, women who consumed ≥3 sodas per day or hamburgers three times a week or more had 58% (CI: 18.0, 112.1) and 20% (CI: -0.2, 45.2) higher urinary BPA concentrations, respectively, compared with women who consumed no sodas or hamburgers. A higher percentage of women who lived their entire life in the United States reported increased consumption of sodas and hamburgers compared with other immigrant women. Independent of other factors, BPA urinary concentrations were slightly higher when the sample was collected later in the day. As in previous studies, high within-woman variability in urinary BPA concentrations confirms that several samples are needed to properly characterize exposure during pregnancy. Results also suggest that some factors could be modified to minimize exposures during pregnancy in our study participants (e.g., reducing soda and hamburger intake) and that factors associated with acculturation might increase BPA concentrations.