ABSTRACT
Introducción.La hipercolesterolemia en los padres sería mejor predictor de hipercolesterolemia en niños que la historia clínica familiar. Objetivos. Comparar las fuerzas de asociación y los valores de predicción de la hipercolesterolemia en padres y la historia clínica familiar positiva con la hipercolesterolemia en hijos. Material y métodos. Estudio analítico, transversal. Se dosó colesterolemia en niños ≥ 6 y < 12 años y sus padres biológicos. Se realizó una encuesta a los padres. Se evaluó la asociación mediante el cálculo de odds ratio. Se determinó su valor de predicción. Se estudió la relación entre la hipercolesterolemia en padres y en hijos usando la regresión multinivel. Resultados. Se evaluaron 332 niños, 304 madres y 206 padres. El análisis entre uno/ambos progenitores con colesterolemia ≥ 240 mg/dl y niños ≥ 200 mg/dl mostró OR= 6,40; IC95 % =2,85-14,48; p <0,0001; sensibilidad= 69 %; espedhcidad= 74 %; valor predictivo positivo (VPP)= 34 %; valor predictivo negativo (VPN)= 93 %; razones de verosimilitud positiva (RVP)= 2,69; negativa (RVN)= 0,42. La historia clínica familiar vs. niños con colesterolemia ≥ 200 arrojó OR= 1,86; IC95 %= 0,84-4,11; p= 0,1272; sensibilidad= 69 %; especificidad= 46 %; VPP= 19 %; VPN= 89 %; RVP= 1,27; RVN= 0,68. Los hijos tuvieron 2,9 y 2,5 más mg/dl de colesterol por cada 10 mg/dl de aumento en colesterol en madres y padres, respectivamente. Conclusiones: La hipercolesterolemia en padres se asoció significativamente con la hipercolesterolemia en hijos y mostró mayor poder de predicción que la historia clínica familiar positiva.
Introduction. Parental hypercholesterolemia would be a better predictor of hypercholesterolemia than family medical history in children. Objectives. To compare the strength of association and predictive values of parental hypercholesterolemia versus a positive family history in pediatric hypercholesterolemia. Material and methods. Cross-sectional, analytical study. Cholesterol levels were measured in children aged ≥ 6 and < 12 years and in their biological parents. A survey was administered to parents. The association was estimated using the odds ratio (OR), and its predictive value was determined. The relationship between hypercholesterolemia in parents and their children was studied with multilevel regression. Results. A total of 332 children, 304 mothers, and 206 fathers were assessed. A cholesterol level ≥ 240 mg/dL in one or both parents and ≥ 200 mg/dL in children showed: OR= 6.40; 95 % confidence interval (CI)= 2.85-14.48; p < 0.0001; sensitivity= 69 %; specihcity= 74 %; positive predictive value (PPV)= 34 %; negative predictive value (NPV)= 93 %; positive likelihood ratio (LR+)= 2.69; negative likelihood ratio (LR-)= 0.42. Family medical history versus children with cholesterol level ≥ 200 showed: OR= 1.86; 95 % CI= 0.84-4.11; p= 0.1272; sensitivity= 69 %; specihcity= 46 %; PPV= 19 %; NPV= 89 %; LR+= 1.27; LR-= 0.68. Cholesterol was 2.9 and 2.5 mg/dL higher per every 10 mg/dL of increased cholesterol in mothers and fathers, respectively. Conclusions: Parental hypercholesterolemia was significantly associated with hypercholesterolemia in children and showed a higher predictive power than a positive family medical history.
Subject(s)
Humans , Child , Adult , Middle Aged , Hyperlipoproteinemia Type II/diagnosis , Hyperlipoproteinemia Type II/blood , Medical History Taking , Research , Cross-Sectional StudiesABSTRACT
Biostatistics plays an important role in measuring, understanding, and describing the overall health and well-being of a population. Biostatistics as a subject evolved from the application of statistics in various research aspects of biology, biomedical care, and public health. However, with a recent increase in number of health and pharmacy related research, the demand for trained biostatisticians is also increasing. The present paper is an attempt to undertake a situational analysis of biostatistics education in India. A systematic, predefined approach, with three parallel strategies was used to collect and assemble the data regarding training in biostatistics in India. Our study results show that there is paucity of programs providing specialized training in biostatistics in India. Only about 19 institutions in India are offering various courses in biostatistics/medical statistics/health statistics/biometry. It is important to look into the current capacity building initiatives in this domain. Some other means for giving importance to biostatistics could be by making it a separate branch/specialization in a majority of the institutions, particularly in medical colleges.
ABSTRACT
La comunidad segura es un modelo de intervención de la Organización Mundial de la Salud (OMS) para el control y la prevención de las lesiones y la violencia basada en la comunidad. El programa está dirigido a la prevención de todos los tipos de lesiones y todos los grupos de edad, ambientes y situaciones. En este modelo, la comunidad identifica sus necesidades organizativas, define las áreas de interés con la participación de todos, diseña e instituye las intervenciones por medio de un trabajo intersectorial y ofrece soluciones locales de bajo costo; asimismo, garantiza la sostenibilidad de los programas mediante el compromiso gubernamental y las alianzas entre diferentes organizaciones. Este modelo ha demostrado su efectividad en diferentes contextos, incluidos los países en desarrollo. En Latinoamérica se ha certificado una "comunidad segura" en Chile, un ejemplo a seguir para enfrentar el problema de las lesiones y la violencia en la región.
The "Safe Community" is a community-based intervention model by the World Health Organization (WHO) for control and prevention of injuries and violence. The program is directed towards the prevention of all types of injuries and to all age groups, environments and situations. In this model, the community identifies its organizational needs, defines interest areas with participation by everybody, designs and implements interventions by means of inter-sector work using local, low cost solutions, and guarantees the sustainability of the programs by means of governmental commitment and alliances among different organizations. This model has demonstrated its effectiveness in different contexts, including developing countries. In Latin America, a "Safe Community" has been certified in Chile, an example to be followed for facing the problem of injuries and violence in the region.
Subject(s)
Humans , Health Promotion , Violence/prevention & control , Wounds and Injuries/prevention & control , Guidelines as TopicABSTRACT
Los programas de intervención para la promoción de la seguridad y la prevención de accidentes se utilizan comúnmente en ambientes ocupacionales. Por ejemplo, la Asociación Chilena de Seguridad (ACHS) periódicamente desarrolla e implementa campañas de seguridad en ambientes ocupacionales seleccionados. Los ambientes laborales pueden ser fábricas, oficinas o cualquier lugar en que haya trabajadores. Son variables en sus características y circunstancias, y así cada programa varía en cuanto a sus componentes, impulsados por necesidades locales, poblaciones de trabajadores y financiamiento. Es imperativo que tales esfuerzos sean evaluados. La evaluación puede ser realizada en una variedad de formas, desde resultados casuales, cualitativos y anecdóticos hasta evaluación científicamente objetiva y rigurosa empleando información cualitativa y cuantitativa. Este documento explora varios procedimientos de evaluación disponibles. Nuestro punto clave es que se necesita una variedad de enfoques, dado que distintos enfoques interesan a diferentes audiencias y propósitos.
Subject(s)
Humans , Accident Prevention , Health Promotion , Safety , Occupational Health/statistics & numerical data , ChileABSTRACT
A well-conducted multicenter study needs to assure standardization, uniformity of procedures, high data quality, and collaboration across sites. This manuscript describes the organization and dynamics of multicenter studies, focusing on governance and administrative structures among countries of diverse cultures. The organizational structure of a multicenter study is described, and a system for oversight and coordination, along with roles and responsibilities of participants in the multicenter study, are presented. The elements of a governance document are also reviewed, along with guidelines and policies for effective collaboration. The experience of an ongoing multi-country collaboration, the World Studies of Abuse in the Family Environment (WorldSAFE), illustrates the implementation of these guidelines. It is essential that multicenter studies have an objective coordinating center and that the investigators jointly develop a written governance document to enable collaboration and preserve collegiality among participating investigators
Subject(s)
Internationality , Multicenter Studies as Topic/methods , Multicenter Studies as Topic/standardsABSTRACT
Background: Clinical research stresses the need for evidence as a basis for setting research agendas. The extent to which current clinical research involves recent advances in biostatistics is not well known. Aim: This manuscript focuses on the use of interim analyses accumulating data in clinical trials. Material and Methods: A PubMed search was conducted for the period 1990-2000. Keywords used included interim analysis, alpha-spending function, and early termination, after subsetting to randomised controlled trials (RCT) that were multicenter since these particular studies are more likely to have external monitoring boards conducting interim analyses. Studies were grouped by clinical discipline and also by journals of high or low impact index. Results: Thirteen thousand two hundred eighty two articles with both RCT and multicenter were found. Of these, the interim analysis keyword yielded 879 articles, of which only 163 (19 percent) studies reported their methodology. The percentages varied by clinical discipline and by journal type. A 25 percent random sample of the articles were further reviewed to investigate the appropriateness of the interim analysis methods used. Discussion: Recent articles in the medical literature attempt to make the interim analysis methods more accessible to clinicians. However, further training of statisticians involved in clinical trials is needed as well
Subject(s)
Humans , Bibliometrics , Clinical Trials as Topic , Periodical/statistics & numerical data , Epidemiologic Research Design , Data Interpretation, Statistical , Research/methods , Meta-AnalysisABSTRACT
Medical research projects that involve any aspect of the collection, summarization, analysis and/or interpretation of clinical quantitative information require statistical support. This input may be provided by the clinicians themselves if properly trained, but is most appropriately and commonly achieved by a relationship with a biostatistician. The biostatistician can be an assistant, a consultant, or a colleague co-investigator. The role of the biostatistician in the research endeavor is one that is partially dictated by the nature of this relationship, but also is one that has evolved considerably in the recent past. This paper reviews the role of the biostatistician in terms of the potential contribution to the research, with special attention to the evolution of this role in light of the fast changes in computation and in statistical methodology. Finally, a method for biostatistical critical appraisal of the biomedical literature is proposed
Subject(s)
Biometry , Research/methods , Computer-Aided Design , Epidemiologic Research DesignABSTRACT
Los accidentes de tránsito han dejado de ser dominio exclusivo de los países desarrollados y se han convertido en una de las principales causas de lesiones, invalidez y muerte en algunos países en desarrollo. La organización Panamericana de la Salud inició recientemente una evaluación epidemiológica sistemática del problema en los países de América Latina y el Caribe. Se elaboró un cuestionario para las investigaciones y se han llevado a cabo talleres con el propósito de recomendar planes de acción. Varios países americanos en desarrollo han suministrado datos actualizados sobre la magnitud del problema y la infraestructura existente en relación con el control del tránsito, la prevención de accidentes, la atención de la salud y la información estadística. En este artículo se examina esa información y se señalan las condiciones que es preciso considerar, entre las cuales se incluyen el estado de los caminos, las actudes de conductores y peatones, los tipos de vehículos y otros factores. se comparan las tasas de defunciones y lesiones por accidentes de tránsito en un grupo de países de América latina y el Caribe con las de los Estados Unidos y Canadá. Se presenta también la información obtenida en dos talleres sobre el problema, uno en el Caribe y otro en Colombia, y se mencionan algunas de las recomendaciones que se propusieron en ellos