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This chapter summarizes the epidemiological study design of natural immune epidemiology studies based on recent COVID-19-related research. The epidemiological studies on antiviral innate immunity have mainly included randomized controlled trials (RCTs) and observational studies. Importantly, this chapter will discuss how to use these methodologies to answer an epidemiological question of natural immunity in the viral infection process based on previous studies. An observational case- or cohort-based study of antiviral innate immunity may support this theoretical hypothesis but is not appropriate for clinical practice or treatment. RCTs are the gold standard for epidemiological studies and occupy a greater role in the hierarchy of evidence.
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COVID-19 , Imunidade Inata , SARS-CoV-2 , Humanos , COVID-19/imunologia , COVID-19/epidemiologia , COVID-19/virologia , SARS-CoV-2/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Epidemiológicos , Antivirais/uso terapêutico , Estudos Observacionais como AssuntoRESUMO
BACKGROUND: In Japan, local governments have rural clinics designated for areas without physicians (RCDA) to secure physicians for rural medical care. Moreover, a medical policy of dispatching physicians between the RCDA and core hospitals for rural areas (CHRA) exists. This study aimed to assess the actual situation of physician migration from RCDAs and those who migrated, and examine the factors associated with their migration. METHODS: This retrospective cohort study used biennial national physicians' survey data from 2012 to 2018. It targeted physicians who worked at RCDAs in 2012 and participated in all four surveys (n = 510). The physicians were divided into two groups. One group consisted of physicians who worked continuously at the RCDA over the four study periods (retained physicians, n = 278), and the other included physicians who migrated to other institutions midway through the study period (migrated physicians, n = 232). We tracked the types of facilities where RCDA physicians worked from 2012 to 2018, also examined the factors associated with their migration. RESULTS: Among physicians from RCDAs who migrated to other institutions (n = 151) between 2012 and 2014, many migrated to hospitals (n = 87/151, 57.6%), and some migrated to CHRA (n = 35/87, 40.2%). Physicians in their 40s (Hazard ratio 0.32 [95% CI 0.19-0.55]), 50s (0.20 [0.11-0.35]), and over 60 years (0.33 [0.20-0.56]) were more likely to remain at RCDAs. Changes in their area of practice (1.82 [1.34-2.45]) and an increase in the number of board certifications held by physicians between 2012 and 2018 (1.50 [1.09-2.06]) were associated with migration. CONCLUSIONS: Many migrating physicians choose to work at hospitals after migrating from RCDAs. It was seemed that the physician dispatch system between RCDA and CHRA has been a measure to secure physicians in rural areas. Young age, obtaining board certification, and changes in areas of practice were associated with physician migration from RCDAs.
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Médicos , Serviços de Saúde Rural , Humanos , Japão , Feminino , Estudos Retrospectivos , Masculino , Médicos/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Área de Atuação Profissional/estatística & dados numéricos , Estudos Epidemiológicos , Emigração e Imigração/estatística & dados numéricosRESUMO
BACKGROUND: Type 2 diabetes, cardiovascular disease, and related cardiometabolic disturbances are increasing rapidly in the Asia-Pacific region. We investigated the contribution of excess adiposity, a key determinant of type 2 diabetes and cardiovascular risk, to unfavourable cardiometabolic profiles among Asian ethnic subgroups. METHODS: The Health for Life in Singapore (HELIOS) Study is a population-based cohort comprising multiethnic Asian men and women living in Singapore, aged 30-84 years. We performed a cross-sectional analysis of data from individuals who had assessment of body composition by dual-energy x-ray absorptiometry and metabolic characterisation. In a subset of participants on no medication for type 2 diabetes, hypertension, and hypercholesterolaemia, we tested the relationship of BMI and visceral fat mass index (vFMI) with cardiometabolic phenotypes (glycaemic indices, lipid levels, and blood pressure), disease outcomes (type 2 diabetes, hypercholesterolaemia, and hypertension), and metabolic syndrome score with multivariable regression analyses. FINDINGS: Between April 2, 2018, and Jan 28, 2022, 10 004 individuals consented to be part of the HELIOS cohort, of whom 9067 were included in the study (5404 [59·6%] female, 3663 [40·4%] male; 6224 [68·6%] Chinese, 1169 [12·9%] Malay, 1674 [18·5%] Indian; mean age 52·8 years [SD 11·8]). The prevalence of type 2 diabetes, hypercholesterolaemia, and hypertension was 8·2% (n=744), 27·2% (n=2469), and 18·0% (n=1630), respectively. Malay and Indian participants had 3-4-times higher odds of obesity and type 2 diabetes, and showed adverse metabolic and adiposity profiles, compared with Chinese participants. Excess adiposity was associated with adverse cardiometabolic health indices including type 2 diabetes (p<0·0001). However, while vFMI explained the differences in triglycerides and blood pressure between the Asian ethnic groups, increased vFMI did not explain higher glucose levels, reduced insulin sensitivity, and increased risk of type 2 diabetes among Indian participants. INTERPRETATION: Visceral adiposity is an independent risk factor for metabolic disease in Asian populations, and accounts for a large fraction of type 2 diabetes cases in each of the ethnic groups studied. However, the variation in insulin resistance and type 2 diabetes risk between Asian subgroups is not consistently explained by adiposity, indicating an important role for additional mechanisms underlying the susceptibility to cardiometabolic disease in Asian populations. FUNDING: Nanyang Technological University-the Lee Kong Chian School of Medicine, National Healthcare Group, and National Medical Research Council, Singapore.
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Absorciometria de Fóton , Adiposidade , Diabetes Mellitus Tipo 2 , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Singapura/epidemiologia , Idoso , Adiposidade/fisiologia , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Estudos Transversais , Idoso de 80 Anos ou mais , Povo Asiático/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etnologia , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Hipertensão/epidemiologia , Hipertensão/etnologia , Estudos EpidemiológicosRESUMO
BACKGROUND: Meta-epidemiological research plays a vital role in providing empirical evidence needed to develop methodological manuals and tools, but the reporting quality has not been comprehensively assessed, and the influence of reporting guidelines remains unclear. The current study aims to evaluate the reporting quality of meta-epidemiological studies, assess the impact of reporting guidelines, and identify factors influencing reporting quality. METHODS: We searched PubMed and Embase for meta-epidemiological studies. The reporting quality of these studies was assessed for adherence to established reporting guidelines. Two researchers independently screened the studies and assessed the quality of the included studies. Time-series segmented linear regression was used to evaluate changes in reporting quality over time, while beta-regression analysis was performed to identify factors significantly associated with reporting quality. RESULTS: We initially identified 1720 articles, of which 125 meta-epidemiological studies met the inclusion criteria. Of these, 65 (52%) had low reporting quality, 60 (48%) had moderate quality, and none achieved high quality. Of the 24 items derived from established reporting guidelines, 4 had poor adherence, 13 had moderate adherence, and 7 had high adherences. High journal impact factor (≥ 10) (OR = 1.42, 95% CI: 1.13, 1.80; P = 0.003) and protocol registration (OR = 1.70, 95% CI: 1.30, 2.22; P < 0.001) were significantly associated with better reporting quality. The publication of the reporting guideline did not significantly increase the mean reporting quality score (- 0.53, 95% CI: - 3.37, 2.31; P = 0.67) or the trend (- 0.38, 95% CI: - 1.02, 0.26; P = 0.20). CONCLUSIONS: Our analysis showed suboptimal reporting quality in meta-epidemiological studies, with no improvement post-2017 guidelines. This potential shortcoming could hinder stakeholders' ability to draw reliable conclusions from these studies. While preregistration could reduce reporting bias, its adoption remains low. Registration platforms could consider creating tailored types for meta-epidemiological research, and journals need to adopt more proactive measures to enforce reporting standards.
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Estudos Epidemiológicos , Humanos , Metanálise como Assunto , Projetos de Pesquisa/normas , Fidelidade a Diretrizes , Relatório de Pesquisa/normas , Fator de Impacto de Revistas , Guias como AssuntoRESUMO
BACKGROUND: Epidemiological studies of long-term exposure to outdoor air pollution have consistently documented associations with morbidity and mortality. Air pollution exposure in these epidemiological studies is generally assessed at the residential address, because individual time-activity patterns are seldom known in large epidemiological studies. Ignoring time-activity patterns may result in bias in epidemiological studies. The aims of this paper are to assess the agreement between exposure assessed at the residential address and exposures estimated with time-activity integrated and the potential bias in epidemiological studies when exposure is estimated at the residential address. MAIN BODY: We reviewed exposure studies that have compared residential and time-activity integrated exposures, with a focus on the correlation. We further discuss epidemiological studies that have compared health effect estimates between the residential and time-activity integrated exposure and studies that have indirectly estimated the potential bias in health effect estimates in epidemiological studies related to ignoring time-activity patterns. A large number of studies compared residential and time-activity integrated exposure, especially in Europe and North America, mostly focusing on differences in level. Eleven of these studies reported correlations, showing that the correlation between residential address-based and time-activity integrated long-term air pollution exposure was generally high to very high (R > 0.8). For individual subjects large differences were found between residential and time-activity integrated exposures. Consistent with the high correlation, five of six identified epidemiological studies found nearly identical health effects using residential and time-activity integrated exposure. Six additional studies in Europe and North America showed only small to moderate potential bias (9 to 30% potential underestimation) in estimated exposure response functions using residence-based exposures. Differences of average exposure level were generally small and in both directions. Exposure contrasts were smaller for time-activity integrated exposures in nearly all studies. The difference in exposure was not equally distributed across the population including between different socio-economic groups. CONCLUSIONS: Overall, the bias in epidemiological studies related to assessing long-term exposure at the residential address only is likely small in populations comparable to those evaluated in the comparison studies. Further improvements in exposure assessment especially for large populations remain useful.
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Poluentes Atmosféricos , Poluição do Ar , Viés , Exposição Ambiental , Estudos Epidemiológicos , Humanos , Exposição Ambiental/análise , Poluição do Ar/análise , Poluição do Ar/efeitos adversos , Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodosRESUMO
INTRODUCTION: Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. METHODS: Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. RESULTS: Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p<0.001) and 36.7% vs. 12.9% (p<0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. CONCLUSIONS: AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. The only independent risk factor for both C-AKI and H-AKI was CKD as comorbidity.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares , Estudos Epidemiológicos , Insuficiência Renal Crônica , Comorbidade , Estudos de Coortes , Diabetes Mellitus , Serviço Hospitalar de Emergência , Hospitais de Ensino , HipertensãoRESUMO
BACKGROUND: Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics. METHODS: For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (Ro) estimates. FINDINGS: Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall Ro was 1·25. INTERPRETATION: Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low Ro. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control. FUNDING: None.
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Surtos de Doenças , Doença pelo Vírus Ebola , Humanos , Uganda/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Masculino , Feminino , Adulto , Criança , Adulto Jovem , Sudão/epidemiologia , Adolescente , Pré-Escolar , Ebolavirus , Pessoa de Meia-Idade , Lactente , Estudos EpidemiológicosRESUMO
BACKGROUND: Vaccine hesitancy is a concerning public health issue, further amplified during the COVID-19 pandemic. Social media is an important player in this context, promoting the dissemination of both information and misinformation. Qualitative studies analyzing the meaning of social media contents in correlation with epidemiological data are scarce, and could aid our understanding of social media's impact on vaccine hesitancy. METHODS: In this study, we identified open-ended responses on reasons to refuse the COVID-19 vaccine collected in an epidemiologic study, and analyzed meaning relations with Twitter posts according to theme categories using a qualitative approach. RESULTS: Among responses to open-ended questions on motivations for refusing the COVID-19 vaccine, we identified and analyzed five theme categories: 1. individuality; 2. fear of adverse events/distrust in vaccine safety; 3. political ideologies/aversion to recommendations issued by the State; 4. skepticism about vaccine efficacy; and 5. refusal of non-natural products or interventions. We observed a close correspondence between open-ended responses in the epidemiological study and Twitter posts in all 5 theme categories. The highest outreach of Twitter posts was observed for those in the "individuality" and "fear of adverse the events/distrust in vaccine safety" theme categories. CONCLUSIONS: Our study suggests that social media interactions can perpetuate misinformation and hesitant attitudes about vaccines. Social media algorithms can intensify ideologic isolation, and strategies to promote the dissemination of tailored health information among social media users should be implemented to promote an overall understanding of health, particularly those concerning the collective wellbeing.
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Vacinas contra COVID-19 , COVID-19 , Mídias Sociais , Hesitação Vacinal , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Hesitação Vacinal/psicologia , Hesitação Vacinal/estatística & dados numéricos , SARS-CoV-2 , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Estudos Epidemiológicos , Masculino , Feminino , Recusa de Vacinação/psicologia , Recusa de Vacinação/estatística & dados numéricos , Comunicação , Medo/psicologiaRESUMO
INTRODUCTION: There is an absence in the application of standardised epidemiological principles when calculating and reporting on lower extremity amputation (LEA) rates [1]. The rates of minor LEAs in the diabetic population range from 1.2-362.9 per 100,000 and in the population without diabetes 0.9-109.4 per 100,000. The reported rates of major lower limb amputations vary from 5.6-600 per 100,000 in the diabetic population and 3.6-58.7 per 100,000 in the total population [1]. The variation in methodology does not facilitate comparison across populations and time. All studies published using the population from England, UK, describing minor amputations were systematically reviewed and rates and methodologies compared. METHOD: A systematic search was carried out using (PRISMA) guidelines [2] to reveal primary data of minor lower extremity amputation rates in England between 1988-2018. This was carried out using electronic databases, grey literature and reference list searching. The search yielded eleven studies that were eligible for review. RESULTS: Significant variation in the reporting of minor lower extremity amputation rates across regional and gender groups in England was found. Rates in the diabetic and non-diabetic population varied from 1.2 to 362.9 per 100,000 and 0.9 to 109.4 per 100,000 respectively. This was predominately a result of poorly describing numerator and denominator populations and defining minor amputations differently. As a result, there was an inability to confidently establish regional, gender and time trends. CONCLUSION: The inconsistent nature of reporting minor amputations makes drawing conclusions on temporal and population change difficult. Future studies should describe and present basic numerator and denominator population characteristics e.g. number, age and sex and use the standard definition of minor amputation as one that is at or below the ankle.
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Amputação Cirúrgica , Pé Diabético , Humanos , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/cirurgia , Pé Diabético/epidemiologia , Inglaterra/epidemiologia , Estudos Epidemiológicos , Extremidade Inferior/cirurgiaRESUMO
Hip pain is a prevalent degenerative joint symptoms, imposing a significant global health burden. Hip pain is experiencing an increase in incidences in Korea due to its aging society, and the social burden of hip pain continues to rise as the hip joint is crucial for gait and balance. This study assessed the epidemiology of hip pain in Korea using data from the fifth version of Korea National Health and Nutrition Examination Survey (KNHANES V-5). The research analyzed data from 8,898,044 Koreans to evaluate the prevalence and characteristics of hip pain and abnormal hip X-ray. Variables encompassed medical, demographic, mental, social, and musculoskeletal factors. Descriptive analysis and propensity score matching analyses unveiled characteristics of Koreans experiencing hip pain or showing abnormal hip x-ray. The study provides insights into the epidemiology of hip pain in the entire Korean population, and further suggesting the effective management of hip pain.
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Articulação do Quadril , Humanos , República da Coreia/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Articulação do Quadril/diagnóstico por imagem , Idoso , Prevalência , Radiografia , Inquéritos Nutricionais , Artralgia/epidemiologia , Dor/epidemiologia , Adulto Jovem , Estudos Epidemiológicos , População do Leste AsiáticoRESUMO
BACKGROUND: Loss to follow-up in long-term epidemiological studies is well-known and often substantial. Consequently, there is a risk of bias to the results. The motivation to take part in an epidemiological study can change over time, but the ways to minimize loss to follow-up are not well studied. The Citizen Science approach offers researchers to engage in direct discussions with study participants and to integrate their opinions and requirements into cohort management. METHODS: Guided group discussions were conducted with study participants from the KORA cohort in the Augsburg Region in Germany, established 40 years ago, as well as a group of independently selected citizens. The aim was to look at the relevant aspects of health studies with a focus on long-term participation. A two-sided questionnaire was developed subsequently in a co-creation process and presented to 500 KORA participants and 2,400 employees of the research facility Helmholtz Munich. RESULTS: The discussions revealed that altruistic motivations, (i.e. supporting research and public health), personal benefits (i.e. a health check-up during a study examination), data protection, and information about research results in layman's terms were crucial to ensure interest and long-term study participation. The results of the questionnaire confirmed these aspects and showed that exclusively digital information channels may be an obstacle for older and less educated people. Thus, paper-based media such as newsletters are still important. CONCLUSIONS: The findings shed light on cohort management and long-term engagement with study participants. A long-term health study needs to benefit public and individual health; the institution needs to be trustworthy; and the results and their impact need to be disseminated in widely understandable terms and by the right means of communication back to the participants.
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Ciência do Cidadão , Opinião Pública , Humanos , Alemanha , Masculino , Feminino , Pessoa de Meia-Idade , Inquéritos e Questionários , Idoso , Adulto , Disseminação de Informação/métodos , Estudos Epidemiológicos , Estudos de Coortes , Registros de Saúde Pessoal , MotivaçãoRESUMO
BACKGROUND: Disease latency is defined as the time from disease initiation to disease diagnosis. Disease latency bias (DLB) can arise in epidemiological studies that examine latent outcomes, since the exact timing of the disease inception is unknown and might occur before exposure initiation, potentially leading to bias. Although DLB can affect epidemiological studies that examine different types of chronic disease (e.g. Alzheimer's disease, cancer etc), the manner by which DLB can introduce bias into these studies has not been previously elucidated. Information on the specific types of bias, and their structure, that can arise secondary to DLB is critical for researchers, to enable better understanding and control for DLB. DEVELOPMENT: Here we describe four scenarios by which DLB can introduce bias (through different structures) into epidemiological studies that address latent outcomes, using directed acyclic graphs (DAGs). We also discuss potential strategies to better understand, examine and control for DLB in these studies. APPLICATION: Using causal diagrams, we show that disease latency bias can affect results of epidemiological studies through: (i) unmeasured confounding; (ii) reverse causality; (iii) selection bias; (iv) bias through a mediator. CONCLUSION: Disease latency bias is an important bias that can affect a number of epidemiological studies that address latent outcomes. Causal diagrams can assist researchers better identify and control for this bias.
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Viés , Causalidade , Humanos , Fatores de Confusão Epidemiológicos , Viés de Seleção , Estudos EpidemiológicosRESUMO
This work presents the Fast Healthcare Interoperability Resources (FHIR®) specification of the NFDI4Health Metadata schema based on FHIR Version 4: We created 16 profiles to facilitate the integration of clinical, epidemiological, and public health study data. Despite challenges arising from the extensive MDS as well as missing concepts in semantic standards, it marks a significant advance in applying information technology standards to health research.
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Interoperabilidade da Informação em Saúde , Nível Sete de Saúde , Metadados , Humanos , Registros Eletrônicos de Saúde , Estudos Epidemiológicos , Saúde Pública , Pesquisa BiomédicaRESUMO
BACKGROUND: Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. METHODS: In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019-22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. RESULTS: Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30-39) compared with other university hospitals (95% CI 6.1-12), county (95% CI 1.9-4.8), district (95% CI 0.07-2.2), and smaller hospitals (95% CI 0.0-22). CONCLUSIONS: Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants.
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Anestesia , Humanos , Suécia/epidemiologia , Lactente , Recém-Nascido , Pré-Escolar , Anestesia/efeitos adversos , Anestesia/mortalidade , Anestesia/métodos , Criança , Masculino , Feminino , Estudos de Coortes , Adolescente , Sistema de Registros , Hospitais Pediátricos/estatística & dados numéricos , Estudos Epidemiológicos , Anestesia PediátricaRESUMO
Introdução:A atenção à Saúde Bucal no Brasil foi qualificada a partir da Política Nacional de Saúde Bucal (PNSB), através do Sistema Único de Saúde (SUS), fomentando ações de promoção, prevenção e recuperação da saúde bucal da população. A avaliação da prevalência de cárie dentária em determinada comunidade, para Estudos Epidemiológicos em Saúde Bucal, pode ser realizada por meio do índice CPOD, que fornece a quantidade média de dentes cariados, perdidos e obturados. Objetivo:O presente trabalho objetivouaferir o índice CPOD dos moradores de uma área coberta pela Equipe de Saúde Bucal (ESB) de um município de pequeno porte, caracterizar seu perfil socioeconômico, verificar seu comportamento quanto ao uso de serviços odontológicos e identificar fatores associados ao índice. Metodologia:Foi realizado um estudo de prevalência do tipo exploratório e descritivo com abordagem quantitativaem residentes de um município de pequeno porte com cobertura pela Equipe de Saúde Bucal. Foi utilizado um questionário de caracterização individual abordando identificação socioeconômica e comportamento relacionado à saúde bucal.Resultados:Na análise do CPOD, a média de dentes perdidos (5,44) foi maior que a dos dentes obturados (4,31) e cariados (1,34). Odesfecho CPOD foi associado positivamente com a idade e a necessidade do uso de prótese dentária.Conclusões:Observou-se uma média mais alta de dentes perdidos, seguida por dentes obturados, e uma média menor de dentes cariados. Verificamos que o índice CPOD individual foi mais elevado em pessoas com mais de 34 anos e naqueles que necessitavam de próteses dentárias (AU).
Introduction:Oral Health care in Brazil was qualified basedon the National Oral Health Policy (PNSB), through the Unified Health System (SUS), promoting actions to promote, prevent and recover the oral healthof the population. Assessing the prevalence of tooth decay in a community, for Epidemiological Studies inOral Health, can be conductedusing the DMFT index, which provides the average number of Decayed, Missing and Filled Teeth. Objective:Thisstudy aimed to measure the DMFT index of residents of an area covered by anOral Health Team (ESB) of a small municipality, characterize their socioeconomic profile, verify their behavior regarding the use of dental services,and identify factors associated with this index. Methodology:An exploratory and descriptive prevalence study was conductedwith a quantitative approach in residents of a small municipality covered by the Oral Health Team. An individual characterization questionnaire addressing socioeconomic identification and behavior related to oral health was used. Results:The total samplewas of 283 individuals with an average of 34 years of age. In the DMFT analysis, the average number of missing teeth (5.44) was higher than that of filled (4.31) and decayed ones(1.34). The occurrence of a DMFTindexgreater than 11 was significantly higher in individuals over 34 years of age (p value 0.000) and in subjects who needed dental prosthesis (p value 0.001). Conclusions:A higher average of missing teeth was observed, followed by filled ones, and a lower average of decayed teeth. The DMFT outcome was positively associated with age and the need to use dental prostheses (AU).
Introducción:La atención a la salud bucal en Brasil ha sido calificada por la Política Nacionalde Saúde Bucal (PNSB), a través del Sistema Único de Saúde (SUS), promoviendo acciones de promoción, prevención y recuperación de la salud bucal de la población. Para estudios epidemiológicos de salud bucal, la prevalencia de caries dental en una determinada comunidad puede ser evaluada utilizando el índice DMFT, que proporciona el número medio de dientes cariados, perdidos y obturados. Objetivo:El objetivo de este estudio fue medir el índice DMFT de los residentes de un área cubierta por el Equipo de Salud Bucal (ESB) de un pequeño municipio, caracterizar su perfil socioeconómico, verificar su comportamiento en cuanto al uso de servicios odontológicos e identificar factores asociados al índice. Metodología:Se realizó un estudio exploratorio y descriptivo de prevalencia con abordaje cuantitativo en residentes de un pequeño municipio cubierto por un Equipo de Salud Bucal. Se utilizó un cuestionario de caracterización individual que abordaba la identificación socioeconómica y el comportamiento relacionado conla salud bucodental. Resultados:La muestra total fue de 283 individuos con una edad media de 34 años. En el análisis de la DMFT, la media de dientes ausentes (5,44) fue superior a la de dientes obturados (4,31) y cariados (1,34). La incidencia de un DMFTsuperior a 11 fue significativamente mayor en los individuos de más de 34 años (valor p 0,000) y en los que necesitaban un tratamiento dental. Conclusiones:Hubo un mayor número medio de dientes ausentes, seguido de dientes obturados, y un menor número medio de dientes cariados. El resultado del DMFT se asoció positivamente con la edad y la necesidad de prótesis dentales (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Estratégias de Saúde Nacionais , Índice CPO , Saúde Bucal , Equipe de Saúde Bucal , Política de Saúde , Brasil/epidemiologia , Estudos Epidemiológicos , Distribuição de Qui-Quadrado , Modelos Logísticos , Estudos Transversais/métodos , Análise Multivariada , Inquéritos e QuestionáriosRESUMO
Introdução:O diabetes mellitustipo 2éuma condição endócrino-metabólica caracterizada pela hiperglicemia crônica decorrente da progressiva perda de sensibilidade periférica à insulina. Com efeito, as mudanças ocorridas nos padrões alimentares e de atividade física nos últimos anos possuem estreita relação com o aumento na prevalência dediabetes mellitus tipo 2mundialmente. Dito isso, é imprescindível a identificação precoce dos hábitos de vida inadequados na população, para que seja possível atuar preventivamente e diminuir os riscos de desenvolvimento da doença. Objetivo:Analisar os fatores de risco e o risco de desenvolvimento de diabetes mellitustipo 2 entre os alunos do curso de medicina, por meio do Escore Finlandês de Risco de Diabetes. Metodologia:Estudo epidemiológico analítico realizado por meio de questionário auto aplicado. As prevalências dos fatores de risco foram calculadas, e o teste do qui-quadrado e/ou Exato de Fisher foram realizados para verificar possível associação dos fatores de risco e o perfil dos entrevistados. 343 estudantes participaram do estudo. Resultados:A pontuação foi de 4,45 na amostra geral, classificado como "risco baixo". Os fatores de risco mais prevalentes foram parentesco com indivíduo portador de diabetes, alimentação não-saudável e sedentarismo. Houve associação entre sexo feminino e sedentarismo e entre sexo masculino e sobrepeso/obesidade. Conclusões:O escore de risco dos estudantes de medicina é considerado baixo e a presença de fatores de risco pode ser associada ao perfil do entrevistado (AU).
Introduction:Diabetes mellitus type 2is an endocrine and metabolic condition characterized by chronic hyperglycemia arising from progressive loss of peripheral sensibility to insulin. Effectively, changes in diet and physical activity in the past years are closely related to the increase in prevalence of diabetes mellitus type 2worldwide. Considering that, it is indispensable to perform an early identification of inadequate populational lifestyles in order to allow preventative measures seeking to decrease the development of this disease. Objective:Analyzing the risk factors and risks of developing diabetes mellitus type 2 among the medicine school students through the Finnish Diabetes Risk Score. Methodology:Analytic epidemiologic study through a self-assessment questionnaire. Risk factors prevalence were calculated and the chi-square test and/or the Fisher's exact test were conducted to verify a possible association between risk factors and interviewees' profile. 343 students have participated in the study. Results:Within the general sampling, the final scorewas 4.45, which is classified as "low risk". The most prevalent risk factors were: being related to individuals with diabetes, unhealthy diet, and sedentarism. There was an association of female individuals and sedentarism, and of male individuals and overweight/obesity. Conclusions:The risk score of the medicine school students is considered low and the appearance of risk factors can be associated to the interviewee's profile (AU).
Introducción: El diabetes mellitus clase 2es una condición endocrino-metabólica caracterizada por la hiperglucemia crónica originada por la progresiva pérdida de sensibilidad periférica a la insulina. En efecto, los cambios que ocurren en los estándares alimentarios y de actividad física en los últimos años tienen relación con el aumento de la prevalencia dediabetes mellitus classe 2mundialmente. Por ello, es importante la identificación temprana de los hábitos de vida no adecuados en la población para que se pueda actuar de manera preventiva y disminuir los riesgos de desarrollo de esta enfermedad. Objetivo: Analizar los factores de riesgo y el riesgo del desarrollo de diabetes mellitus clase 2 entre los alumnos del curso de medicina, a través del Score Finlandés de Riesgo de Diabetes. Metodología: Estudios epidemiológico-analíticos hechos a través de encuestas auto aplicadas. Las prevalencias de los factores de riesgo se calculan y el test de chicuadrado y/o Exacto de Fisher serealizan para verificar la posible asociación de los factores de riesgo y el perfil de los entrevistados. 343 estudiantes participan del estudio. Resultados: La puntuación es de 4,45 en la muestra general, clasificado como "riesgo bajo". Los factores de riesgo más prevalentes fueron parentesco con individuo que tiene diabetes, alimentación no sana y sedentarismo. Hubo asociación entre sexo femenino y sedentarismo y entre sexo masculino y sobrepeso/obesidad.Conclusiones: El score de riesgo de los estudiantes de medicina es considerado bajo y la presencia de factores de riesgo puede asociarse al perfil del entrevistado (AU).
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Estudantes de Medicina , Diabetes Mellitus Tipo 2/patologia , Estilo de Vida , Brasil/epidemiologia , Estudos Epidemiológicos , Distribuição de Qui-Quadrado , Estudos Transversais/métodos , Inquéritos e Questionários , Fatores de Risco , Comportamento AlimentarRESUMO
OBJECTIVE: We aimed to demonstrate the use of quantitative bias analysis (QBA), which reveals the effects of systematic error, including confounding, misclassification and selection bias, on study results in epidemiological studies published in the period from 2010 to mid-23. METHOD: The articles identified through a keyword search using Pubmed and Scopus were included in the study. The articles obtained from this search were eliminated according to the exclusion criteria, and the articles in which QBA analysis was applied were included in the detailed evaluation. RESULTS: It can be said that the application of QBA analysis has gradually increased over the 13-year period. Accordingly, the number of articles in which simple is used as a method in QBA analysis is 9 (9.89%), the number of articles in which the multidimensional approach is used is 10 (10.99%), the number of articles in which the probabilistic approach is used is 60 (65.93%) and the number of articles in which the method is not specified is 12 (13.19%). The number of articles with misclassification bias model is 44 (48.35%), the number of articles with uncontrolled confounder(s) bias model is 32 (35.16%), the number of articles with selection bias model is 7 (7.69%) and the number of articles using more than one bias model is 8 (8.79%). Of the 49 (53.85%) articles in which the bias parameter source was specified, 19 (38.78%) used internal validation, 26 (53.06%) used external validation and 4 (8.16%) used educated guess, data constraints and hypothetical data. Probabilistic approach was used as a bias method in 60 (65.93%) of the articles, and mostly beta (8 [13.33%)], normal (9 [15.00%]) and uniform (8 [13.33%]) distributions were selected. CONCLUSION: The application of QBA is rare in the literature but is increasing over time. Future researchers should include detailed analyzes such as QBA analysis to obtain inferences with higher evidence value, taking into account systematic errors.
Assuntos
Viés , Estudos Epidemiológicos , Humanos , Viés de Seleção , Fatores de Confusão EpidemiológicosRESUMO
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common female cardiometabolic-reproductive disorder. It is unclear whether the global obesity epidemic is impacting the high PCOS prevalence. OBJECTIVE: To determine the association between the prevalence of PCOS and obesity. MATERIALS AND METHODS: A systematic review was conducted to identify population studies on PCOS prevalence globally through July 2023. Linear regression and random-effect models were applied to examine the association of mean body mass index (BMI) or obesity prevalence with the prevalence of PCOS diagnosed by 1990 National Institutes of Health (NIH), 2003 Rotterdam (Rotterdam), and 2006 Androgen Excess-PCOS (AE-PCOS) criteria. Subgroup analyses were also conducted for recruitment methods and study quality. RESULTS: Fifty-eight studies with 85 956 adults from 24 countries were included. Considering all available data, a borderline association was observed between PCOS and obesity prevalence when using the AE-PCOS but not the NIH or Rotterdam criteria. Alternatively, subgroup analysis of studies with better recruitment methods demonstrated a significant positive association of population mean BMI or obesity prevalence with PCOS prevalence when using the Rotterdam or AE-PCOS criteria, while using only high-quality studies revealed an association using NIH as well as Rotterdam and AE-PCOS criteria. Overall, we observed that a 1% increase in obesity prevalence resulted in an approximately 0.4% increase in PCOS prevalence by the Rotterdam criteria. CONCLUSION: The prevalences of PCOS and obesity appear to be modestly associated, although our data cannot establish causality. This study also emphasizes the need to undertake only high-quality studies in assessing PCOS epidemiology.
Assuntos
Índice de Massa Corporal , Obesidade , Estudos Observacionais como Assunto , Síndrome do Ovário Policístico , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/complicações , Humanos , Feminino , Obesidade/epidemiologia , Obesidade/complicações , Prevalência , Adulto , Estudos EpidemiológicosRESUMO
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.