Ocorrência de enteroparasitas antes e durante a pandemia da COVID-19 em Nina Rodrigues, Maranhão - Brasil / Occurrence of enteroparasites before and during the COVID-19 pandemic in Nina Rodrigues, Maranhão, Brazil

Parasitoses intestinais são infecções no trato gastrointestinal, por protozoários e/ou helmintos e representam um agravo à saúde pública, mas apesar dessa problemática, foram notificadas menos do que seria esperado devido a pandemia da COVID-19. O objetivo desse estudo foi verificar a ocorrência de enteroparasitas antes e durante a pandemia da COVID-19 em pacientes atendidos no laboratório do hospital de Nina Rodrigues, Maranhão. Foi realizado um estudo tranversal, descritivo e quantitativo, sendo analisados os exames dos anos de 2019 e 2020, coletados do banco de informações do hospital em agosto de 2021. Os dados foram inseridos no programa STATA 14.0 para análise. Em 2019 foram realizados 632 exames, e 2020 um total de 161, as mulheres e os adultos de meia idade (31-59 anos) foram os que mais realizaram exames, em relação aos laudos positivos, 18,51% e 26,09% apresentavam pelo menos um tipo de parasita em 2019 e 2020, respectivamente. O parasita mais ocorrente foi Entamoeba coli e 66,48% dos laudos tinham a presença de mais de um parasita, sendo a associação mais observada E. coli + Entamoeba histolytica. Nota-se que apesar do período pandêmico de 2020 ter sido realizado menos exames parasitológicos de fezes em comparação o período de 2019, é possível constatar que há uma ocorrência razoável de enteroparasitas na população de Nina Rodrigues, com um alto índice de indivíduos com biparasitismo. Assim, torna-se necessário a implementação de medidas que visem o diagnóstico e o tratamento dos infectados, e medidas de prevenção para minimizar a transmissão.

Intestinal parasites are infections in the gastrointestinal tract, by protozoa and/or helminths and represent a public health problem, but despite this problem, less were reported than would be expected due to the COVID-19 pandemic. The objective of this study was to verify the occurrence of enteroparasites before and during the COVID-19 pandemic in patients treated at the laboratory of the Nina Rodrigues hospital, Maranhão. A cross-sectional, descriptive, and quantitative study was carried out, analyzing the exams from the years 2019 and 2020, collected from the hospital's information bank in August 2021. The data were entered into the STATA 14.0 program for analysis. In 2019, 632 exams were performed, and in 2020 a total of 161, women and middle-aged adults (31-59 years old) were the ones who most underwent exams, in relation to positive reports, 18.51% and 26.09% had at least one type of parasite in 2019 and 2020, respectively. The most frequent parasite was Entamoeba coli and 66.48% of the reports had the presence of more than one parasite, the most observed association being E. coli + Entamoeba histolytica. It is noted that despite the 2020 pandemic period, fewer fecal parasitological tests were performed compared to the 2019 period, it is possible to verify that there is a reasonable occurrence of enteroparasites in the population of Nina Rodrigues, with a high rate of individuals with biparasitism. Thus, it is necessary to implement measures aimed at diagnosing and treating those infected, and preventive measures to minimize transmission.

Moderator role of vitamin D concentrations on the association between metabolic syndrome and C-reactive protein among adults

ABSTRACT Objective To evaluate the association between MetS, its components and insulin resistance (IR) with 25(OH)D and hsCRP. The moderator role of 25(OH)D in the association of MetS, its diagnostic components and IR with hsCRP were also explored. Materials and methods A cross-sectional study (2014/2015) with a population-based cohort in Southern Brazil (n = 605). Metabolic syndrome (MetS) diagnosis was defined based on the Joint Interim Statement, while the Homeostasis Model Assessment of insulin resistance (IR) (HOMA-IR) was used for determining IR. Serum concentrations of 25-hydroxy vitamin D [25(OH)D] (ng/mL) and high sensitivity C-reactive protein (hsCRP) (mg/L) were evaluated following standard protocols. 25(OH)D was categorized as sufficiency (>30 ng/mL), insufficiency (20-30 ng/mL) or deficiency (<20 ng/mL) to test its moderator role. Multiple linear regression was used to test the associations. The results were adjusted for possible confounders. Results and discussion Hypertriglyceridemia and IR were associated with lower 25(OH)D concentrations. However, except for systolic blood pressure, other MetS components and IR were associated with higher hsCRP. The association between elevated waist circumference (WC) and hsCRP was moderated by the 25(OH)D concentrations. The hsCRP median concentrations were more than two times higher among those with elevated WC and 25(OH)D insufficiency or deficiency. In this study, inadequate concentrations of 25(OH)D increased the adverse relationship between elevated WC and inflammation. 25(OH)D concentrations could be incorporated into the clinical protocols for monitoring individuals with abdominal obesity to identify those at a higher risk of complications.

Serie de Redacción Científica: Estudio de Casos y Controles / Scientific Writing Series: Case-Control studies

Introducción: Un estudio de casos y controles es un estudio en el que se compara individuos que tuvieron un desenlace de interés o outcome (casos) versus individuos que no tuvieron dicho resultado (controles) con respecto a la exposición de interés, potencialmente un "factor de riesgo" o "factor de protección". El objetivo de un estudio de casos y controles es primariamente determinar si existe asociación entre una exposición (o varias) y un desenlace de interés. Esta asociación debe ser cuantificada y reportada como un odds ratio o razón de momios teniendo en cuenta sus fortalezas y limitaciones. En general, este tipo de estudios ofrece como ventajas su relativo bajo costo y rapidez con la que es posible realizarlos. Sin embargo, no son idóneos si lo que se quiere investigar son desenlaces de interés frecuente o con periodos de latencia largos. En el presente artículo se han revisado las principales consideraciones metodológicas del diseño de los estudios de casos y controles esperando con ello contribuir objeto de promover su correcta utilización e interpretación.

Introduction: A case-control study is a study comparing individuals who had an outcome of interest (cases) versus individuals who had no such outcome (controls) with respect to the exposure of interest, potentially a "risk factor "or" protection factor." The objective of a case-control study is primarily to determine if there is an association between one exposure (or several) and an outcome of interest. This association must be quantified and reported as an odds ratio or odds ratio taking into account its strengths and limitations. In general, this type of study offers as advantages its relatively low cost and speed with which it is possible to carry them out. However, they are not ideal if what you want to investigate are frequent outcomes or with long latency periods. In this article, the primary methodological considerations of the design of case-control studies have been reviewed, hoping thereby to contribute to promoting their correct use and interpretation.

Analysis of influencing factors for liver cancer by gender in Shunde region / 中华疾病控制杂志

Objective To investigate the influencing factors for liver cancer by gender in Shunde region, and to explore the potential interactions among influencing factors for liver cancer in males. Methods The relative excess risk of interaction (RERI) and other indices were used to evaluate the pair-wise interaction, and the classification and regression tree (CART) model was applied to explore the potential multi-factors interaction. Results This study included 1 037 male cases and 1 069 controls, together with 166 female cases and 185 controls. Chronic hepatitis B virus infection (CHB) and family history of liver cancer were significantly associated with increased risk of liver cancer both in males and females (both P<0.001). In males, positive additive interactions were observed between CHB and smoking or alcohol drinking, as well as between smoking and drinking. The RERI for CHB and smoking was 121.90(95% CI：52.85%-190.95%). Negative additive interactions were observed between exercise and CHB or smoking. Further, the CART analysis suggested that the CHB males who smoked and drank alcohol had the highest risk of liver cancer. Conclusions CHB and family history of liver cancer are important risk factors for liver cancer in both males and females. CHB, smoking, and alcohol drinking synergistically promote the incidence of liver cancer for males. Exercise can antagonize the hepatocarcinogenic effect of CHB and smoking.

Risk of bias assessment: (9) Application of the risk of bias assessment results / 中华流行病学杂志

In this last paper of the series about risk of bias assessment,we introduce the application of risk of bias assessment results.Risk of bias assessment is one of the key steps in the assessment of quality of evidence.The risk of bias assessment results could be the “diagnosis” of individual studies,which helps decision making related to the inclusion and exclusion of individual studies,as well as the data analysis in the systematic review process.This paper focuses on how to incorporate risk of bias assessment results in the GRADE assessment for quality of evidence,including the principles and the tips for the application.

Risk of bias assessment: (9) Application of the risk of bias assessment results / 中华流行病学杂志

In this last paper of the series about risk of bias assessment,we introduce the application of risk of bias assessment results.Risk of bias assessment is one of the key steps in the assessment of quality of evidence.The risk of bias assessment results could be the “diagnosis” of individual studies,which helps decision making related to the inclusion and exclusion of individual studies,as well as the data analysis in the systematic review process.This paper focuses on how to incorporate risk of bias assessment results in the GRADE assessment for quality of evidence,including the principles and the tips for the application.

Risk of bias assessment: (1) overview / 中华流行病学杂志

This paper reviews the concept of risk of bias,followed by demonstrating why assessment of risk of bias in systematic reviews should be different from that of quality of evidence,methodological quality,reporting quality,precision,and external validity.We also discuss the recent development of tools for risk of bias assessment,the problems with the tools themselves,and the challenges in using these tools.This review may help systematic reviewers understand risk of bias assessment and the use of assessment tools.

Risk of bias assessment: (1) overview / 中华流行病学杂志

This paper reviews the concept of risk of bias,followed by demonstrating why assessment of risk of bias in systematic reviews should be different from that of quality of evidence,methodological quality,reporting quality,precision,and external validity.We also discuss the recent development of tools for risk of bias assessment,the problems with the tools themselves,and the challenges in using these tools.This review may help systematic reviewers understand risk of bias assessment and the use of assessment tools.

Investigación epidemiológica y medicamentos: farmacoepidemiología / Epidemiological research and medicines: pharmacoepidemiology

La Farmacoepidemiología, como disciplina que estudia los efectos y consecuencias del uso de medicamentos en poblaciones humanas, tiene como objetivo fundamental promover su uso adecuado. Para ello se sustenta en el método epidemiológico y sus diversos diseños de investigación, cada uno de los cuales presenta objetivos y características particulares, pero todos con el propósito global de mejorar el uso de medicamentos, prevenir eventos adversos y sus factores asociados; así como, descubrir nuevas indicaciones, determinar posibles efectos nocivos por uso crónico, describir las posibles interacciones con otros medicamentos, identificar el desarrollo de nuevas patologías, además del uso en poblaciones especiales, entre otros. Entre las acciones de la Farmacoepidemiología destacan la aplicación de la investigación para la producción de evidencia científica sólida para la toma de decisiones en salud; así como para la ejecución de acciones de capacitación destinadas a mejorar las prácticas en torno al medicamento de pacientes, proveedores, personal de salud, industria, gobierno y público en general. La presente revisión pretende hacer una breve descripción de los principales diseños de investigación epidemiológica y su vinculación con el uso de medicamentos, destacando como principales ventajas, además de la diversa disponibilidad de métodos, la sencillez, rapidez y facilidad de ejecución de la mayoría de ellos, aunado al hecho de destacar los esfuerzos que se vienen realizando mediante la publicación de guías dirigidas a mejorar la divulgación de resultados, esperando que estas actividades se traduzcan en una mejora en el uso adecuado de medicamentos en la población, su salud y calidad de vida

Pharmacoepidemiology, as a discipline that studies the effects and consequences of the use of drugs in human populations, has as its fundamental objective to promote its adequate use. This is based on the epidemiological method and its various research designs, each of which presents particular objectives and characteristics, but all with the overall purpose of improving drug use, preventing adverse events and their associated factors; as well as to discover new indications, to determine possible harmful effects by chronic use, to describe the possible interactions with other drugs, to identify the development of new pathologies, besides the use in special populations, among others. Among the actions of Farmacoepidemiología, the application of research for the production of solid scientific evidence for health decision making emphasizes; as well as for the execution of training actions aimed at improving practices around the medicine of patients, providers, health personnel, industry, government and the public in general. The present review aims to give a brief description of the main designs of epidemiological research and their linkage with the use of medicines, highlighting as main advantages, besides the diverse availability of methods, the simplicity, speed and ease of execution of most of them , coupled with the fact that efforts are being made by publishing guidelines aimed at improving the dissemination of results, hoping that these activities will result in an improvement in the adequate use of medicines in the population, their health and quality of life

Opportunity and challenge on molecular epidemiology / 中华流行病学杂志

Molecular epidemiology,a branch of epidemiology,combines the theories and methods,both in epidemiology and molecular biology.Molecular epidemiology mainly focuses on biological markers,describing the distribution,occurrence,development and prognosis of diseases at the molecular level.The completion of Human Genome Project and rapid development of Precision Medicine and Big Data not only offer the new development opportunities but also bring about a higher demand and new challenge for molecular epidemiology.

Opportunity and challenge on molecular epidemiology / 中华流行病学杂志

Molecular epidemiology,a branch of epidemiology,combines the theories and methods,both in epidemiology and molecular biology.Molecular epidemiology mainly focuses on biological markers,describing the distribution,occurrence,development and prognosis of diseases at the molecular level.The completion of Human Genome Project and rapid development of Precision Medicine and Big Data not only offer the new development opportunities but also bring about a higher demand and new challenge for molecular epidemiology.

Rol del equipo de investigación cubano en la identificación del origen de la epidemia de cólera en Haití / Role played by the Cuban research team in the identification of the origin of the cholera epidemic in Haiti

Objetivo: realizar la investigación epidemiológica de terreno acerca de la aparición de casos de diarreas agudas acuosas profusas y el control epidemiológico correspondiente. Métodos: se efectuó el análisis del brote de esta enfermedad con la participación del personal de salud cubano que laboraba en la comuna de Mirebalais, y se intercambiaron informaciones y criterios con el Director Departamental de Salud de Haití. Con toda la información recopilada, se comenzó la investigación epidemiológica de este evento de salud que estaba ocurriendo. Se elaboró la cronología de la aparición de los casos de la enfermedad en la comuna de Mirebalais, del Departamento Centro. Se inspeccionaron las áreas de hospitalización de los enfermos y se comprobó su estado clínico. Se dictaron otras medidas para la prevención y el control de otros casos similares. Fueron visitados, inspeccionados y analizados por el equipo de investigación cubano los asentamientos donde aparecieron casos o fallecidos por el evento epidemiológico y se efectuó la investigación ambiental en el terreno. Resultados: la rápida y oportuna alerta emitida por la brigada médica cubana sobre el aumento inusual de casos de diarreas agudas acuosas profusas permitió realizar la investigación y establecer las medidas para la prevención y el control del brote epidemiológico por el equipo de investigación cubano. Conclusiones: Al equipo médico cubano le corresponde el mérito de haber identificado precozmente el verdadero lugar donde se originaron y aparecieron los primeros casos de la epidemia de cólera en Haití.

Objective: The purpose of this study was to conduct field epidemiological research into the appearance of profuse acute watery diarrhea and the corresponding epidemiological control. Methods: An analysis was made of the outbreak of this disease with the participation of Cuban health personnel working in the commune of Mirebalais. Data and criteria were exchanged with the Haitian Departmental Director of Health. When all the required information had been gathered, the epidemiological research started. A chronology was developed of the occurrence of cases of the disease in the commune of Mirebalais, in the Central Department. Hospitalization areas were inspected and their clinical status checked. Other measures were instructed aimed at the prevention and control of similar cases. The Cuban research team visited, inspected and examined the settlements with cases or deaths caused by the epidemiological event, and a field environmental analysis was conducted. Results: The swift and timely alert issued by the Cuban medical brigade about the unusual increase in cases of profuse acute watery diarrhea made it possible to conduct the research and adopt the measures required to prevent and control the epidemiological outbreak. Conclusions: The Cuban research team had the merit of identifying at an early stage the origin and the true place where the first cholera cases appeared during the Haiti epidemic.

<b>Expectations and Challenges Regarding the Use of the SS-MIX in a Clinical Trial </b> / 薬剤疫学

While there is an advantage to be able to directly utilize some research database of medical information must solve several problems. It also includes support for international standardization, led by computerized system validation, and CDISC. We should countermeasures with epidemiological studies using SS-MIX standardized storage, in anticipation of its application to clinical trials in the near future in Japan. (Jpn J Pharmacoepidemiol 2013；18(1)：35-39)

Hiperidrose na cidade de Botucatu prevalência, orientação, tratamento e qualidade de vida / Hyperhidrosis in the city of Botucatu: prevalence, cousehing, treatment and quality of life

Hiperidrose é um distúrbio caracterizado pela secreção inapropriada e excessiva de suor. Sua etiologia pode ser primária (HP) ou idiopática e secundária (HS) a outras desordens e sua prevalência não é bem definida. Estabelecer a prevalência da hiperidrose na cidade de Botucatu- Brasil. Orientar os pacientes quanto à patologia e suas prováveis formas de tratamento e avaliar a qualidade de vida relacionada à HP. Foi realizado um inquérito populacional para identificar os casos de hiperidrose em indivíduos maiores de cinco anos, moradores na zona urbana da cidade de Botucatu, localizados por intermédio de amostragem sistemática de conglomerados. Foi calculado um número amostral de 4.033 participantes, utilizando-se os mapas censitários da cidade; a seguir, foram sorteadas quadras de cada setor para obter-se os domicílios. Dez entrevistadores previamente treinados foram responsáveis por aplicar um questionário que avaliou a presença de sudorese excessiva. Após análise dos questionários os indivíduos que referiram hiperidrose foram entrevistados por um médico para confirmação ou não do diagnóstico. Todos os indivíduos foram orientados e, caso houvesse indicação, o tratamento foi oferecido. Foram visitados 1.351 domicílios totalizando 4.113 moradores, sendo 2.150 (52,3%) do gênero feminino. A idade variou de cinco a 97 anos (média ± DP = 38,3 ± 21,2). Oitenta e cinco indivíduos (2,07%) queixavam-se de suor excessivo, sendo 51 (60%) do gênero feminino com idade variando de cinco a 72 anos (média ± DP = 33,9 ± 17,3). O efeito psicossocial mais frequente devido à sudorese foi o constrangimento, e o fator predisponente mais frequente foi o nervosismo. Cinquenta e um indivíduos (60%) concordaram em receber a visita médica para a confirmação do diagnóstico...

The hyperhidrosis is characterized by the excessive sweating and its etiology can be primary or idiopathic (PH) and secondary (SH) to other diseases but its prevalence is not well defined. To establish the PH prevalence in the city of Botucatu- Brazil. To perform orientation related to the pathology and its probable forms of treatment and evaluate the quality of life related to PH. A population survey was performed in order to identify the cases of hyperhidrosis in individuals aged over five years, residents in Botucatu urban area and selected by cluster systematic sampling. A sample number of 4,033 participants was calculated using the Census maps from the city and a selection of blocks in each sector was carried out in order to obtain the households. Ten previously trained interviewers were responsible for applying a questionnaire that evaluated the presence of excessive sweating. After the questionnaires analysis the individuals that referred hyperhidrosis were interviewed by a physician in order to confirm the diagnosis. All subjects were instructed and the treatment was offered in case of indication. 1,351 households were surveyed with a total of 4,113 residents, in which 2,150 (52.3%) were female. The age ranged from five to 97 years (average ± MD = 38.3 ± 21.2). Eighty-five individuals complained about excessive sweating (2.07% prevalence); 51 female (60%), anging from five to 72 years (average ± MD = 33.9 ± 17.3). The most frequent psychosocial effect related to excessive sweating was the embarrassment whereas the most frequent predisposing factor was nervousness. Fifty-one individuals (60%) agreed to receive medical evaluation in order to confirm the diagnosis. Twenty-three (45%) had PH (0.93% prevalence), 15 (29.4%) had SH caused by obesity as well as menopause or thyroid disorder and 13 (25.5%) individuals had normal sweating...

Histórico del proceso de creación de la Escuela de Odontología de la Universidad del Valle: primera acción investigativa de base: estudio de recursos Odontológicos en el Área sur-occidental de Colombia / Historical review of the process of creation of the Dental School of the Universidad del Valle: first base action of investigation: study of dentistry resources in the southwestern area of Colombia

Se presenta el resultado de la única Investigación Epidemiológica Cuantitativo–Cualitativa Regional e Interinstitucional que se ha realizado en América Latina como base para la fundación de una Facultad de Odontología. En 1.969, por acción integrada de la Sección de Odontología Sanitaria del Departamento de Medicina Preventiva y de Salud Publica de la Universidad del Valle y del Programa de Especialización en Odontología Sanitaria y de Salud Pública de la Escuela de Salud Pública de la Universidad de Antioquia, con la Asesoría de la Organización Panamericana de la Salud “OPS”, se llevó a cabo una investigación de campo en Odontología cuyos métodos y resultados generales, algunos de cuyos hallazgos se presentan en este manuscrito, se utilizaron como fundamento para la toma de decisiones curriculares por parte del Comité Universitario Pro Facultad de Odontología de la Universidad del Valle, “CUPFO” y por el Consejo Directivo de la Universidad para aprobar, en Junio de 1.970, la creación del Departamento de Estomatología de la División de Salud (por la Reforma Administrativa llevada a cabo en 1.968, las Facultades de disciplinas afines se agruparon en unos nuevos entes administrativos: las Divisiones. Dentro de estas, las antiguas y las nuevas Facultades pasaron a ser Departamentos) en la mencionada Alma Mater. La investigación incluyó algunos aspectos que no fueron tomados en cuenta en el Estudio de Recursos Humanos para la Salud que formó parte de la Encuesta Nacional de Morbilidad realizada en 1.965, aspectos que si se incluyeron en el Estudio de Recursos Odontológicos llevado a cabo por el Instituto Nacional para Programas Especiales de Salud, del cual el autor de la Reseña que aquí se presenta fue Asesor - Consultor y Odontólogo de trabajo de Campo en las Unidades de Cali, Santa Rosa de Cabal y Quibdó.

Results of the unique Epidemiological Quantitative - Qualitative Regional and Interinstitutional Research performed at Latin America as essential base to found a new Dental School are presented trough this paper. In 1969 by a cooperative work between the Universidad del Valle, Cali, Colombia and the Antioquia University Public Health and Sanitarian Dentistry Program, on the advice of the Pan American Health Dental Health (PAHO) it was carried out a field research to establish the dental health practice conditions and the data obtained were used as a baseline of curricular determination by the Pro Dental Scholl Committee at the Universidad del Valle “CUPFO”. The study took on accountsome aspects that have been neglected on the National Health Human Resources Research as part of the National Morbidity Research Study realized on 1965 but included in the Dental Health Resources Research performed by the National Special Health Resources Institute. It is necessary to clarify that the author of the present paper participated as a special member of the advisors committee and as field dentist of the Dental Health Resources Research realized by theNational Special Health Resources Institute in 1.965.

Ethics in epidemiological research

This text focus, on a series of author's opinions, on the difficulties that the current system of regulation of ethics in research represents for the practice of the epidemiological research, in the Country. It introduces a few understandings concerning the present subject in the international literature, pointing out some of the most relevant themes and problems. It also examines part of the difficulties faced by Brazilian epidemiologists. The main topic developed in the article is the specificity of the science's reasoning that guides acting of the public health and epidemiology with repercussions for the practice of scientific research in this field, plenty different from the science's reasoning that preside medical practice and biomedical research. Hence the inadequacy of the ethical recommendations in force, all of them based on biomedical research, particularly at that with experimental design. It concludes with the indication that procedures adopted by the system of the ethics in research should be reviewed, adapting such procedures to the characteristics of different kinds of research.

Este artigo reúne uma série de opiniões do autor sobre as dificuldades que o atual sistema de controle da ética em pesquisa representa para a prática da pesquisa epidemiológica no país. São apresentadas algumas posições referentes ao assunto presentes na literatura internacional, apontados alguns dos temas e problemas mais relevantes e discutidas algumas das dificuldades enfrentadas pelos epidemiologistas brasileiros. O argumento principal desenvolvido no artigo é a especificidade da lógica de atuação da saúde pública e da epidemiologia em seu interior com repercussões para a prática da pesquisa científica nesse campo, bastante diferente da lógica que preside a prática médica e a pesquisa biomédica. Daí a inadequação das recomendações éticas vigentes, todas elas baseadas na pesquisa biomédica, em particular, naquelas com desenho experimental. Conclui-se com a indicação da necessidade de revisão dos procedimentos adotados pelo sistema de revisão da ética em pesquisa adaptando-os às características dos diferentes tipos de pesquisa.