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RESUMEN La anorexia nerviosa es un trastorno con altos niveles de cronicidad. Sin embargo, los datos epidemiológicos referidos al pronóstico suelen obviar la probabilidad de recuperación a lo largo del tiempo, refiriéndose de manera exclusiva al inicio del curso del trastorno. El objetivo de este artículo es mostrar cómo varía la probabilidad de recuperación de los pacientes con anorexia nerviosa a lo largo del tiempo a partir de la información obtenida de un estudio publicado por Theander en 1985 con datos que abarcan un período medio de observación de 33 años. La pertinencia del presente estudio radica en que el cuidado de los pacientes que la padecen requiere un conocimiento adecuado de las posibilidades de éxito terapéutico en cada momento de la evolución del trastorno y no solo en su inicio. Es conveniente ofrecer datos sobre la evolución temporal de las probabilidades de recuperación y cronicidad, que brindan una visión más ajustada de las perspectivas terapéuticas.
ABSTRACT Anorexia nervosa is a disorder with high levels of chronicity. However, epidemiological data related to prognosis usually obviate the probability of recovery over time, referring exclusively to the beginning of the course of the disorder. The objective of this article is to show how the probability of recovery of patients with anorexia nervosa varies over time based on the information obtained from a study published by Theander in 1985 with data covering an average observation period of 33 years. The relevance of the present study lies in the fact that the care of patients who suffer from it requires an adequate knowledge of the possibilities of therapeutic success at each moment of the evolution of the disorder and not only at its onset. It is convenient to offer data on the temporal evolution of the probabilities of recovery and chronicity, which provide a more accurate view of the therapeutic perspectives.
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Abstract Introduction Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using "AMSTAR" and "Systematic Reviews" as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of a SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.
Resumen Introducción Tomar decisiones basadas en la evidencia ha sido un reto para profesionales de la salud; se requiere tener herramientas y habilidades para apreciar la evidencia críticamente y evaluar la validez de los resultados. Las revisiones sistemáticas de la literatura (RSL) han sido muy usadas para dar respuesta a preguntas del ámbito clínico. Se han desarrollado herramientas que apoyan la apreciación de la calidad de los estudios. El AMSTAR es una de estas, validada y soportada por evidencia reproducible que orienta la calidad metodológica de las RSL. Objetivos Mostrar un abordaje histórico, teórico y de guía práctica para la apreciación crítica de las revisiones sistemáticas con el AMSTAR, orientar las bases argumentales para su uso, según los componentes de esta estructura metodológica en investigación en salud, y proporcionar ejemplos prácticos sobre cómo aplicar esta lista de chequeo. Métodos Realizamos una revisión no exhaustiva de literatura en PubMed y The Cochrane Library con los términos libres "AMSTAR" y "revisiones sistemáticas'', sin límite de idioma o año de publicación; también, recolectamos información de expertos en evaluación de la calidad de la evidencia. Conclusiones El AMSTAR es un instrumento validado y soportado por evidencia reproducible para la evaluación de la validez interna de las revisiones sistemáticas de la literatura. Consiste en 16 ítems que evalúan de manera global la calidad metodológica de una RSL. Actualmente, se usa de manera indiscriminada y predilecta, pero no está exenta de limitaciones y futuras actualizaciones basadas en nuevos estudios de reproducibilidad y validación.
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Humans , Quality Assurance, Health Care , Epidemiologic Methods , Evidence-Based Practice , Review Literature as Topic , Meta-Analysis as Topic , Instruments for Management of Scientific ActivityABSTRACT
Objective@#To understand the epidemiologic characteristics and pathogen spectrum of hand, foot and mouth disease (HFMD) in Hunan Province during 2008—2017 and provide the basis for the prevention and control strategy of hand, foot and mouth disease.@*Methods@#Collecting data from national disease reporting information system throughout 2008—2017, the descriptive epidemiological method were used to analyze the data of HFMD monitoring and the result of pathogenic agent detection.@*Results@#A total of 1, 255, 530 HFMD cases were reported throughout 2008—2017, including 10097 severe cases and 394 deaths. The average annual attack rate is 190.38/100, 000. The peak incidence of HFMD occurred in summer and fall. The reported incidence is on the rise. The number of critically ill and the number of deaths is declining. Proportion of male cases was higher than that of females. The majority of the children were those under 5 years of age. Enterovirus (EV)-A71, coxsackievirus (CV)-A16 and other other EV positive cases accounted for 33.29%, 20.04% and 46.67% of laboratory diagnosed cases.@*Conclusions@#The epidemic of hand, foot and mouth disease in Hunan has obvious seasonal and population characteristics. There are different dominant pathogens causing HFMD in different years.
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Evidence-based medicine remains the best paradigm for medical practice.However,evidence alone is not decisions;decisions must also consider resources available and the values of people.Evidence shows that most of those treated with blood pressure-lowering,cholesterol-lowering,glucose-lowering and anti-cancer drugs do not benefit from preventing severe complications such as cardiovascular events and deaths.This implies that diagnosis and treatment in modem medicine in many circumstances is imprecise.It has become a dream to identify and treat only those few who can respond to the treatment.Precision medicine has thus come into being.Precision medicine is however not a new idea and cannot rely solely on gene sequencing as it was initially proposed.Neither is the large cohort and multi-factorial approach a new idea;in fact it has been used widely since 1950s.Since its very beginning,medicine has never stopped in searching for more precise diagnostic and therapeutic methods and already made achievements at various levels of our understanding and knowledge,such as vaccine,blood transfusion,imaging,and cataract surgery.Genetic biotechnology is not the only path to precision but merely a new method.Most genes are found only weakly associated with disease and are thus unlikely to lead to great improvement in diagnostic and therapeutic precision.The traditional multi-factorial approach by embracing big data and incorporating genetic factors is probably the most realistic way ahead for precision medicine.Big data boasts of possession of the total population and large sample size and claims correlation can displace causation.They are serious misleading concepts.Science has never had to observe the totality in order to draw a valid conclusion;a large sample size is required only when the anticipated effect is small and clinically less meaningful;emphasis on correlation over causation is equivalent to rejection of the scientific principles and methods in epidemiology and a call to give up the assurance for validity in scientific research,which will inevitably lead to futile interventions.Furthermore,in proving the effectiveness of intervention,analyses of real-world big data cannot displace the role of randomized controlled trial.We expressed doubts and critiques in this article on precision medicine and big data,merely hoping to stimulate discussing on the true potentials of precision medicine and big data.
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Evidence-based medicine remains the best paradigm for medical practice.However,evidence alone is not decisions;decisions must also consider resources available and the values of people.Evidence shows that most of those treated with blood pressure-lowering,cholesterol-lowering,glucose-lowering and anti-cancer drugs do not benefit from preventing severe complications such as cardiovascular events and deaths.This implies that diagnosis and treatment in modem medicine in many circumstances is imprecise.It has become a dream to identify and treat only those few who can respond to the treatment.Precision medicine has thus come into being.Precision medicine is however not a new idea and cannot rely solely on gene sequencing as it was initially proposed.Neither is the large cohort and multi-factorial approach a new idea;in fact it has been used widely since 1950s.Since its very beginning,medicine has never stopped in searching for more precise diagnostic and therapeutic methods and already made achievements at various levels of our understanding and knowledge,such as vaccine,blood transfusion,imaging,and cataract surgery.Genetic biotechnology is not the only path to precision but merely a new method.Most genes are found only weakly associated with disease and are thus unlikely to lead to great improvement in diagnostic and therapeutic precision.The traditional multi-factorial approach by embracing big data and incorporating genetic factors is probably the most realistic way ahead for precision medicine.Big data boasts of possession of the total population and large sample size and claims correlation can displace causation.They are serious misleading concepts.Science has never had to observe the totality in order to draw a valid conclusion;a large sample size is required only when the anticipated effect is small and clinically less meaningful;emphasis on correlation over causation is equivalent to rejection of the scientific principles and methods in epidemiology and a call to give up the assurance for validity in scientific research,which will inevitably lead to futile interventions.Furthermore,in proving the effectiveness of intervention,analyses of real-world big data cannot displace the role of randomized controlled trial.We expressed doubts and critiques in this article on precision medicine and big data,merely hoping to stimulate discussing on the true potentials of precision medicine and big data.
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Uma vez disponíveis, as informações de Ingestão Alimentar (IA) podem permitir o desenvolvimento de estratégias para intervir, acompanhar e explorar padrões dietéticos com métodos estatísticos mais sofisticados. Assim, o objetivo do presente artigo foi documentar as características quantitativas da IA em adultos em um inquérito domiciliar em Niterói, RJ. Realizou-se recordatório de 24 horas de um dia típico. Os alimentos mais ingeridos (> 50%) foram arroz branco, café, feijão, açúcar refinado e pão francês. Leite integral foi mais ingerido do que leite desnatado ou semidesnatado. Carne de vaca foi mais ingerida que carne de frango, peixe ou porco. Mais adultos ingeriram refrigerantes do que sucos, e frutas tiveram ingestão relativamente alta (63,3%). A combinação de arroz, feijão, carne e pão francês foi responsável por 25% da ingestão de energia, proteínas e carboidratos, e 17% da ingestão de lipídeos. Um total de 65 alimentos correspondeu a 90% da ingestão de energia e macronutrientes. O presente estudo gerou uma lista de alimentos mais frequentemente ingeridos, que é bastante semelhante ao que foi observado em inquérito anterior realizado em São Paulo, capital, o que pode servir como base para a geração de um questionário de frequência alimentar único para a população urbana do sudeste brasileiro.
Once it is available, the information on food intake (FI) may enable the development of strategies to intervene, monitor and explore dietary patterns with more sophisticated statistical methods. Thus, the purpose of this study was to document the quantitative dietary characteristics in a probabilistic sample of adults in Niterói in the State of Rio de Janeiro. A 24-hour dietary recall of a typical day was conducted. The food eaten by most adults (> 50%) was white rice, coffee, black beans, refined sugar and French bread. Whole milk was ingested by more adults than skimmed or semi-skimmed milk. Beef was ingested by more adults than chicken, fish or pork. More adults ingested sodas than fruit juices and fruits were eaten by a relatively high percentage of adults (63.3%). The combination of white rice, black beans, beef and French bread was responsible for at least 25% of energy, protein and carbohydrate and 17% of lipids. A total of 65 food items accounted for approximately 90% of energy and macronutrients. The list generated is somewhat similar to the one used in a similar survey conducted in São Paulo. The list can serve as the basis for a single food frequency questionnaire to be used for the southeastern Brazilian urban population.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Diet , Food , Brazil , Diet Surveys , EatingABSTRACT
As causas externas vêm se configurando uma das principais causas demorbimortalidade no mundo em razão do crescente número de pessoas que morrem a cada ano em decorrência da violência. Objetivou-se descrever o perfil epidemiológico de mortalidade por causas externas no município de Jequié, Bahia. Trata-se de um estudo descritivo, transversal, que utiliza dados secundários do Departamento de Informaçãoem Saúde (DIS) da Secretaria de Saúde do Estado da Bahia (Sesab), disponível no Sistema de Informação de Mortalidade (SIM), referentes a Jequié no período de 2006 a 2010, fundamentando-se nos eventos vitais (morte). Dos dados obtidos foram calculados números absolutos, proporções e taxas de concordância bruta, no indicador de mortalidade,utilizando-se o programa Epi-info versão 3.5.1. Para ajustar o efeito da estrutura etária sobre o Coeficiente Geral de Mortalidade (CGM), empregou-se o método direto de padronização. Os resultados apontam que, no período avaliado, o risco de morrer por causas externasaumentou 46,93por cento. Os homicídios e acidentes de transportes foram responsáveis por 79,9por cento dos óbitos. Quanto ao perfil, em 2010, 82,57por cento ocorreram em indivíduos do sexo masculino, 44,95por cento com idade entre 20 e 39 anos, 71,56por cento da raça negra e 41,28por cento ocorreram em ambiente hospitalar. Conclui-se que, em residentes de Jequié, aumentou o risco de morrer por causas externas, sendo o valor obtido superior ao do estado da Bahia, vitimando principalmente homens jovens.
This study aimed to describe the epidemiological profile of mortality fromexternal causes in the municipality of Jequié, Bahia. This is a descriptive transversal study using secondary data from the Department of Health Information (DIS), the Health Department of the State of Bahia (SESAB) and the Information System (SIM), in Jequié, during the period of 2006 to 2010. The data collection was based on vital statistics. Data were obtained from SESAB/DIS/SIM, and the absolute numbers, proportions and rates of concordance and the indicator of mortality were calculated using Epi-Info version 3.5.1. In order to adjust the effect of age structure on the General Mortality Ratio (CGM), we used the direct standardizationmethod. In the period evaluated, the risk of dying from external causes increased by 46.93percent. Homicides and traffic accidents were responsible for 79.9percent of deaths. According to the profile, in 2010, 82.57percent of deaths occurred in males, 44.95percent aged between 20 and 39 years, 71.56percent were black and 41.28percent occurred in hospitals. It is concluded that residents in Jequié increased the risk of dying from external causes, being higher than the value obtained from the State of Bahia, the victims are mostly black young men.
Las causas externas se configuran como una de las causas principales de morbidez en el mundo, en razón del creciente número de personas que mueren a cada año en recurrencia de la violencia. Este estudio tuvo como objetivo describir el perfil epidemiológico de la mortalidad por causas externas en el municipio de Jequié, Bahia. Se trata de un estudio descriptivo, transversal, utilizando datos secundarios del Departamento deInformación de Salud (DIS) de la Secretaría de Salud del Estado de la Bahía (Sesab), disponible en el Sistema de Información de Mortalidad (SIM), referentes a Jequié, en el período de 2006 a 2010, basándose en los acontecimientos vitales (muerte). Los datos obtenidos fueroncalculados en números absolutos, proporciones y tasas de concordancia bruta, en el indicador de la mortalidad, usando el programa Epi-Info versión 3.5.1. Para ajustar el efecto de la estructura por edad sobre el Coeficiente General de Mortalidad (CGM), se utilizó el método directo de estandarización. Los resultados muestran que, en el período evaluado, el riesgo de morir por causas externas aumentó en un 46,93por ciento. Los homicidios y los accidentes de tráfico fueron responsables por 79,9por ciento de las muertes. Cuanto al perfil, en 2010, 82,57por cientopor ciento ocurrieron con varones, 44,95por ciento con edades comprendidas entre 20 y 39 años, 71,56por ciento eran de raza negra y 41,28por ciento ocurrieron en ambiente hospitalario. Se concluye que, en los residentes de Jequié aumentó el riesgo de morir por causas externas, siendo el valor obtenido más alto que el del Estado de la Bahía, victimando principalmente hombres jóvenes.
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Humans , Male , Adult , Epidemiologic Methods , External Causes , Information Systems , Mortality , Violence , Brazil/epidemiology , Cross-Sectional StudiesABSTRACT
PURPOSE: Recently, the trend of multi-cultural families is rising in number due to increasing marriage-based immigrants in Korea. We evaluated statistic changes of characteristics in international marriage, births, and off-springs for the past 20 years in Korea. METHODS: The annual report of national population from Statistics Korea, the survey results about the present status of resident foreigners from Korea Ministry of Health and Welfare, Korea Ministry of Public Administration and Security, and editorials from Health and Welfare Forum and other related reports of Korea Institute for Health and Social Affairs and Korea Ministry of Health and Welfare were used. RESULTS: There were 35,098 (10.8%) international marriages among total 326,104 marriages in 2010 in Korea. The regional distribution of the international marriage was the highest in Gyeonggi (18.5%), and the lowest in Jeju (1.1%). The metropolitan area Seoul (15.4%), Incheon (4.5%) and Gyeonggi (18.3%) comprised one third of the entire international marriage. The number of childbirths was 13,443 (2.9%) in 2008, 19,024 (4.3%) in 2009, and 20,312 (4.3%) in 2010 with increasing trend. The number of off-springs was 44,258 in 2007, 58,007 in 2008, 99,684 in 2009 and 105,502 in 2010. Children less than 18 years old was 93.1%. We expected 1.5 times of increase over the next coming 10 years in the number of multi-cultural international marriage and off-springs compared with 2011. CONCLUSION: When we evaluated the characteristics of multi-cultural marriages, childbirths, and off-springs, systemic nationwide care seemed to be necessary in the aspect of health problems such as perinatology, obstetrics, neonatology, and pediatrics. We expect our results to be utilized for the basic health data.
Subject(s)
Child , Humans , Birth Rate , Emigrants and Immigrants , Epidemiologic Methods , Korea , Marriage , Neonatology , Obstetrics , Parturition , Pediatrics , PerinatologyABSTRACT
PURPOSE: In Korea before 1996, the perinatal mortality rates (PMRs) were reported by individual studies, but the Korea Ministry of Health and Welfare started official reports of PMRs from 1996, and Statistics Korea provides the annual official data since 2007. The present study observed the decreasing trends of PMR and compared the PMRs between OECD nations. Thereby, we surveyed the terminology of PMR and the international trends in the usage of the calculation methods and intended to provide uniformity in calculating PMR in Korea. Also, the authors speculated some perinatal problems to be improved in the future in order to decrease PMR further. METHODS: Data before 1996 were gathered from individual reports, and after 1996 were utilized from Ministry of Health and Welfare, and Statistics Korea. Data of OECD nations were analyzed from OECD Health Data 2010. The changes in annual PMR of Korea was reviewed, which is helpful to recognize the current state of Korea, and was compared to that of OECD nations. RESULTS: During the past 50 years, the PMRs of Korea were remarkably improved (PMRs: 60 in 1960s, 35 in 1970s, 30 in 1980s, approximately, respectively). The official PMR values of Korea are as following: 6.0 in 1996, 5.2 in 1999, 4.6 in 2002, 4.2 in 2005, 3.6 in 2006, 3.7 in 2007, 3.6 in 2008, and 3.4 in 2009. The decreasing pattern of the annual PMR value was observed and the most recent value reflected the excellent situation in PMR compared to other OECD nations. CONCLUSION: Accordingly, we could observe the encouraging levels of PMR in Korea. We speculate that following efforts should be accompanied to achieve further improvement in PMR, such as improvements in neonatal and maternity transfer system, establishment in perinatal care centers, and establishment in perinatal research network system in Korea.
Subject(s)
Epidemiologic Methods , Korea , Perinatal Care , Perinatal Mortality , Public Health , Vital StatisticsABSTRACT
Curvas de referência para valores de parâmetros antropométricosna população são amplamente utilizadas por profissionais desaúde. Técnicas estatísticas de construção de modelosmatemáticos relacionadas com a idade desenvolveram-sebastante nos últimos 10 anos e tem sido uma área de especialinteresse em vários centros de pesquisas no mundo. A evoluçãodo poder de processamento dos computadores pessoais contribuiude maneira significativa para esta mudança nos métodos deanálise de regressão até então utilizados. A publicação do EstudoMulticêntrico de Referência do Crescimento da OMS (2006) criouum novo paradigma para construção de curvas de crescimento, eem consequência, implicou em um amplo questionamento arespeito das curvas anteriormente publicadas e atualmente emuso em várias áreas da saúde. O objetivo deste artigo foi exporde maneira concisa e sem aprofundamento dos aspectosmatemáticos as bases metodológicas da modelagem estatísticautilizando uma nova classe de modelos estatísticos chamadaModelos Aditivos Generalizados para Posição, Escala e Forma(GAMLSS) proposta por RIGBY e STASINOPOULOS (2005).Demonstrou-se a aplicação do método GAMLSS na elaboraçãode um modelo com dados empíricos, a utilização das ferramentasde diagnóstico e de seleção do modelo de melhor ajuste, aconstrução de uma curva de referência e o cálculo facilitado dospercentis e z-escores através de funções específicas. Conclui-seque o método GAMLSS é uma importante ferramenta de modelagemestatística na área da saúde e que em futuras pesquisasprovavelmente será o estado da arte na construção de novascurvas de referência ou na validação de curvas já construídas.
Reference curves for values of anthropometric parameters of apopulation are widely used by healthcare professionals.Statistical techniques for the construction of age-relatedmathematical models have developed a lot in the last 10years and this has been an area of particular interest in severalresearch centers around the world. The evolution of theprocessing power of personal computers has contributedsignificantly to this change in the methods of regression analysisused until then. The WHO publication of the Multicenter GrowthReference Study (MGRS) in 2006 created a new paradigm forthe construction of growth curves, which, consequently, resultedin a broad discussion on the curves previously published andcurrently in use in several healthcare areas. The aim of thisexhibit was to expose in a concise way without furtherconsideration of the mathematical aspects themethodological bases of statistical modeling using a new classof statistical models called Generalized Additive Models forPosition, Scale and Shape (GAMLSS) proposed by RIGBYand STASINOPOULOS (2005). The application of the GAMLSSmethod to design a model with empirical data wasdemonstrated, as well as the use of diagnostic tools and theselection of the model of best fit, the construction of a curve ofreference and easier calculation of percentiles and z-scoresthrough specific functions. It is concluded that the GAMLSSmethod is an important tool for statistical modeling inhealthcare and that in future research it will probably be thestate of the art in the construction of new reference curves or inthe validation of curves already built.
Subject(s)
Epidemiologic Methods , Models, Statistical , Regression AnalysisABSTRACT
Objective To understand the status of human resources for AIDS control at city and county level in Hebei Province,and to improve the outfit of human resources.Methods General investigation and self-designed questionnaire were used by the trained investigators.Epi Data 3.0 was used to establish a database,and SPSS 13.0 was used to analyze the data.Results There were 1 347 missionaries at the city and county level,547 of whom were full-time staff.Significant differences existed in academic qualifications and titles between city and county level.A lack in technical staff in county level appeared.Conclusions The number of staff for HIV control in Hebei is not sufficient.Therefore human resources in these places should be strengthened and rationally allocated for AIDS control.
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We describe three birth cohort studies, respectively carried out in 1978/79 and 1994 in Ribeirão Preto, a city located in the most developed region of Brazil, and in 1997/98 in São Luís, a city located in a less developed region. The objective of the present report was to describe the methods used in these three studies, presenting their history, methodological design, objectives, developments, and difficulties faced along 28 years of research. The first Ribeirão Preto study, initially perinatal, later encompassed questions regarding the repercussions of intrauterine development on future growth and chronic adult diseases. The subjects were evaluated at birth (N = 6827), at school age (N = 2861), at the time of recruitment for military service (N = 2048), and at 23/25 years of age (N = 2063). The study of the second cohort, which started in 1994 (N = 2846), permitted comparison of aspects of perinatal health between the two groups in the same region, such as birth weight, mortality and health care use. In 1997/98, a new birth cohort study was started in São Luís (N = 2443), capital of the State of Maranhão. The 1994 Ribeirão Preto cohort and the São Luís cohort are in the second phase of joint follow-up. These studies permit comparative temporal analyses in the same place (Ribeirão Preto 1978/79 and 1994) and comparisons of two contrasting populations regarding cultural, economic and sociodemographic conditions (Ribeirão Preto and São Luís).