Método indirecto para la verificación del intervalo de referencia del perfil lipídico / Indirect method for the verification of the lipid profile reference range

Introducción: La dislipidemia es uno de los problemas más frecuentes en los niños y adolescentes y su estudio es importante debido a su fuerte correlación con la enfermedad cardiovascular aterosclerótica en adultos. Muchos países desarrollaron valores de referencia nacionales investigando los lípidos séricos utilizando datos basados en la población nacional propia. Nuestro objetivo fue verificar el intervalo de referencia del perfil lipídico calculando las curvas de percentiles a través del método indirecto en nuestra población pediátrica. Materiales y métodos: Se analizaron los resultados de nuestra base de datos utilizando el método indirecto. Luego de aplicar filtros y criterios de exclusión se calcularon los percentiles 25, 50, 75, 95 y 99 para colesterol total (CT), colesterol HDL (C-HDL), colesterol no HDL (C-no-HDL), triglicéridos (TG) y colesterol LDL (C-LDL) y para el C-HDL además se calculó el percentil 10. El valor de referencia para el cambio (RCV) se utilizó para determinar si existía diferencia clínicamente significativa entre los valores de percentiles obtenidos y los utilizados en el consenso de la SAP. Resultados: No se evidenció diferencia clínicamente significativa contra los valores propuesto por la SAP, excepto para los TG para las edades 1,5,7 años en el percentil 95 y para la edad de 8 años en el percentil 75 y 95; para el C-HDL en el percentil 10 para las edades 1,16 y 17 años. Discusión: Se obtuvieron los percentiles de los lípidos y se compararon con los valores de referencia utilizados por el consenso en el que están basados las guías (AU)

Introduction: Dyslipidemia is one of the most common problems in children and adolescents and its study is important because of its strong correlation with atherosclerotic cardiovascular disease in adulthood. Many countries have developed national reference values investigating serum lipids using data based on their own national population. Our aim was to verify the lipid profile reference range by calculating percentile curves through the indirect method in our pediatric population. Materials and methods: The results of our database were analyzed using the indirect method. After applying filters and exclusion criteria, the 25th, 50th, 75th, 95th, and 99th percentiles were calculated for total cholesterol (TC), HDL cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), triglycerides (TG), and LDL cholesterol (LDL-C); for HDL-C, the 10th percentile was also calculated. The reference change values (RCV) were used to determine whether there was a clinically significant difference between the percentile values obtained and those used in the consensus of the Argentine Association of Pediatrics (SAP). Results: There was no clinically significant difference with the values proposed by the SAP, except for TG for ages 1, 5, and 7 years at the 95th percentile and for age 8 years at the 75th and 95th percentile; and for HDL-C at the 10th percentile for ages 1, 16, and 17 years. Discussion: Lipid percentiles were obtained and compared with the reference values used by the consensus on which the guidelines are based (AU)

High incidences of hepatocellular carcinoma – A report from Population-Based Cancer Registry Center in Western Arunachal Pradesh

Background: Primary hepatocellular carcinoma (HCC) is a major health hazard and frequent cause of liver cancers accounting 90% of cancers of liver worldwide. It has high mortality, prevalence, and incidence rate in Sub-Saharan, South Africa, and South-east Asia. Its etiology is associated with infection, dietary habits, and lifestyle factors. Aims and Objectives: The present study was designed to discuss the various possible etiologies for high incidence of HCC in Western Arunachal Pradesh, India. Materials and Methods: Data were collected as one among 33 population-based cancer registries in India under national cancer registry program of national center for disease informatics and research, Indian Council of Medical Research between 2012 and 2014 in Tomo Riba Institute of Health and Medical Sciences, Naharlagun. Data were represented in frequency and percentage using descriptive statistics. Results: With 194 cases, HCC represented 13.5% of overall malignancies in the region. It is 3 times more common in males than in females. Age-adjusted incidence rate for men was 21.44 and for women was 7.05. Conclusion: Western Arunachal Pradesh reported high incidence of hepatocellular carcinoma in the world. This finding may be associated with high prevalence of hepatitis and alcoholism in the region and perhaps also associated with local food habits.

Systematic review of factors influencing sunburn from population-based studies / 环境与职业医学

Sunburn is an acute phototoxic reaction caused by excessive exposure of skin to solar ultravilet (UV) or artificial UV light sources. Studies show that sunburn is common in the general population, so that associated financial burden cannot be ignored. Meanwhile, sunburn at any age increases the risk of melanoma. Only by clarifying the influencing factors of sunburn can precise preventive measures be formulated. Although many studies have been conducted on the influencing factors of sunburn worldwide, there are great heterogeneity in reported influencing factors. In this paper, by means of systematic review, factors affecting sunburn were sorted out and summarized from four aspects, including demographic and socioeconomic characteristics, photosensitive phenotypes, UV-related environmental factors, and sun protection knowledge, attitude & behavior. Combined with population characteristics and data availability in China, our review provided reference for subsequent research and development of precise prevention and control strategies.

Prevalência de saúde cardiovascular ideal na população adulta brasileira - Pesquisa Nacional de Saúde 2019 / Prevalencia de salud cardiovascular ideal en la población adulta brasileña - Encuesta Nacional de Salud 2019 / Prevalence of ideal cardiovascular health in the Brazilian adult population - National Health Survey 2019

Objective: to analyze the prevalence of ideal cardiovascular health (CVH) in the Brazilian adult population based on the 2019 National Health Survey. Methods: this was a population-based cross-sectional study (n = 77,494); prevalence and respective 95% confidence intervals (95%CI) of ideal CVH (seven metrics achieved simultaneously) and by individual metrics (four behavioral and three biological metrics), as defined by the American Heart Association, were estimated. Results: only 0.5% (95%CI 0.4;0.6) of the study population presented ideal CVH, with higher prevalence among those with higher level of education (1.3%; 95%CI 0.9;1.6) and residents in urban areas (0.6%; 95%CI 0.5;0.7); the prevalence of behavioral and biological metrics was 0.7% (95%CI 0.6;0.8) and 63.3% (95%CI 62.7;63.9) respectively. Conclusion: the prevalence of ideal CVH was very low, highlighting the need for public policies aimed at promotion, surveillance and CVH care in the Brazilian adult population.

Objetivo: analizar la prevalencia de salud cardiovascular (SCV) ideal en la población adulta brasileña con base en la Encuesta Nacional de Salud de 2019. Métodos: estudio transversal de base poblacional (n = 77.495). Según lo propuesto por la Asociación Americana del Corazón, la prevalencia y los intervalos de confianza del 95% (IC95%) del SCV ideal se estimaron globalmente (siete metas alcanzadas simultáneamente) y por metas individuales (cuatro metas de comportamiento y tres metas). Se calculó la prevalencia de las metas por variables sociodemográficas. Resultados: sólo el 0,5% (IC95% 0,4;0,6) de la población presentó SCV ideal, siendo más frecuente en aquellos con educación superior (1,3%; IC95% 0,9;1,6) y entre los residentes de áreas urbanas (0,6%; IC95%0,5;0,7). La prevalencia de las metas de comportamiento y biológicas fue de 0,7% (IC95% 0,6;0,8) y 63,3% (IC95% 62,7;63,9), respectivamente. Conclusión: la prevalencia de SCV ideal en adultos brasileños es muy baja, destacando la necesidad de políticas públicas para la promoción, vigilancia y atención a la SCV en la población adulta brasileña.

Objetivo: analisar a prevalência de saúde cardiovascular (SCV) ideal na população adulta brasileira. Métodos: estudo transversal com base na Pesquisa Nacional de Saúde de 2019 (n = 77.494); foram estimadas as prevalências e respectivos intervalos de confiança de 95% (IC95%) de SCV ideal (sete metas alcançadas simultaneamente) e por metas individuais (quatro metas comportamentais; três biológicas), conforme propõe a Associação Americana do Coração. Resultados: apenas 0,5% (IC95% 0,4;0,6) da população estudada apresentou SCV ideal, observando-se maior prevalência entre aqueles com maior escolaridade (1,3%; IC95% 0,9;1,6) e os residentes em áreas urbanas (0,6%; IC95% 0,5;0,7); as prevalências das metas comportamentais e biológicas foram de 0,7% (IC95% 0,6;0,8) e 63,3% (IC95% 62,7;63,9) respectivamente. Conclusão: a prevalência de SCV ideal foi muito baixa, evidenciando a necessidade de políticas públicas para promoção, vigilância e atenção à SCV na população adulta brasileira.

Prevalence of diabetic retinopathy in rural Pakistan: A population based cross-sectional study

Purpose: To estimate the prevalence of diabetic retinopathy (DR), an emerging cause of sight threat and blindness from a large rural population in Pakistan. Methods: This was a population?based cross?sectional study. We selected a rural district of Matiari Sindh Province in Pakistan, where we selected all the health facilities and their attached Lady Health Workers (LHWs)/Lady Health Supervisors (LHSs). These female health workers were trained to identify high?risk diabetic individuals in their catchment areas using pre?defined criteria and to refer them to the nearest health facilities for screening and testing random blood sugar (BSR). Adults of 18 years or above, male or female, were included in the study for DM and DR screening. Ophthalmic examination was conducted by the optometrists on those who had BSR level >180 mg/dl for the evidence of DR. Identified DR patients were referred to a linked tertiary?level ophthalmology institute for their free DR treatment. Results: Of the identified and referred 24,463 participants, 23,999 were tested for BSR and 2,331 (9.74%) were found to be high?risk patients (BSR >180 mg/dl) and had ophthalmic examination conducted. Of these, 563 had clinically established DR, a prevalence of 24.2% (95% CI, 22–26%). Significantly more DR patients (228, 40.5%) were found in the age group >60 years, with more among female (327, 58.1%) with DR. Conclusion: DR is highly prevalent in the Pakistani rural population. The establishment of an integrated approach within the health care system could decrease the burden of DR in Pakistan

Underage drinking in Brazil: findings from a community household survey

Objectives: Previous studies have estimated the 30-day prevalence of alcohol use to be approximately 21% among youth in Brazil, despite the legal drinking age of 18 years. The present study aimed to determine the prevalence of underage drinking and its associated factors among adolescents in Brazil. Methods: The 3rd National Survey on Drug Use by the Brazilian Population (III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira) is a nationwide, multi-stage, probability-sample household survey. Herein, youth between the ages of 12-17 years were included. Lifetime and 12-month alcohol use prevalence were estimated. Factors associated with 12-month alcohol use were evaluated through multivariate analysis considering survey weights and design. Results: Overall, 628 youth were interviewed. Estimated lifetime and 12-month alcohol use were 34.3% (standard error [SE] = 1.9) and 22.2% (SE = 1.7), respectively. Factors associated with 12-month drinking were: other/no religion vs. Christianity; living in rural vs. urban areas; self-reported diagnosis of depression vs. no self-reported depression; lifetime tobacco use vs. no history of tobacco use; and any illicit drug use vs. no history of illicit drug use. Conclusion: Considering that alcohol use is a major risk factor for early death among Brazilian youth, our findings highlight the importance of preventative measures to reduce underage drinking.

Population-based assessment of barriers for uptake of eye care services among elderly people: Findings from rapid assessment of visual impairment studies from Telangana, India

Purpose: To report the barriers for seeking eye care among the elderly population aged ?60 years with avoidable vision impairment (VI) in the South Indian state of Telangana. Methods: A total of 3640 participants aged ?60 years were recruited using cluster?random sampling. Demographic information, including presenting visual acuity, was measured using the standard Rapid Assessment of Visual Impairment (RAVI) protocol. “Avoidable VI” was considered if the VI was due to cataract or uncorrected refractive error (URE). A detailed interview was conducted using a validated questionnaire to report the barriers for not seeking eye care. Data were analyzed using the Stata statistical software version 14. Results: Prevalence of avoidable VI was 30.2% (95% CI: 28.02–31.06; n = 1102). Among those who noticed decreased vision (n = 1074), only 392 participants (36.4%) reported that they felt the need for seeking eye care. The major barriers for not seeking eye care were: cannot afford the consultation fee and services (42.0%) and no escort (25.7%). Overall, the personal barriers (57.9%) were the major reason for not seeking care, followed by economic barriers (42.0%). No significant difference was reported in barriers between the participants with unilateral and bilateral VI (>0.05). Conclusion: Overall, among the elderly people, personal and economic barriers were the major reason for not seeking eye care. Health care providers and policymakers should focus on newer models of eye care delivery to ensure better accessibility and uptake of care by the elderly people

Evaluation of mood disorder questionnaire positivity and associated factors in a population-based screening study

The Mood Disorders Questionnaire (MDQ) is a 3-item scale that is frequently used in bipolar disorders (BD) screening and questions the symptoms of BD, its effect on functionality, and the coexistence of symptoms. The aim of this study is to evaluate the prevalence of positive screening of the MDQ among general population and to investigate the associated risk factors. In this cross-sectional study, the sample was randomly selected from household data to represent the city population. A total of 432 participants were asked to fill in MDQ, CAGE (cutting down, annoyance by criticism, guilty feeling, and eye-openers) questionnaire, which consists of four clinical interview questions proven to aid in the diagnosis of alcoholism, and clinical and sociodemographic data form. The Cronbach's alpha value of our current study was 0.813 for MDQ. The prevalence of MDQ positivity was found 7.6%. The estimated prevalence rate of bipolar disorders varied between 0.3 and 13.4% according to different cut-off values. Multivariate logistic regression models showed that the presence of possible alcohol addiction, shift work history, and body mass index (BMI) were statistically significant predictors of MDQ positivity. The prevalence of MDQ positivity found is similar to studies in literature. Keeping in mind that psychometric properties of the MDQ, positive screen results should be cautiously interpreted due to the presence of other risk factors and comorbidities. (AU)

Screening tool for restrictive and obstructive ventilatory abnormalities in a population-based survey

Abstract Background: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. Objectives: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. Methods: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] <5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). Results: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with <87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. Conclusions: An FEV1 <87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.

Why Brazilian women suffer more from depression and suicidal ideation: a mediation analysis of the role of violence

Objective: We aimed to investigate the mediating effect of violence by a family member or acquaintance on biological sex, depression and suicidal ideation. Methods: We used data from the 2013 Brazilian National Health Survey, a cross-sectional nationwide survey. Major depressive episode and suicidal ideation were evaluated with the Patient Health Questionnaire. Violence victimization and other sociodemographic variables were self-reported. We used logistic regression to estimate the OR, 95%CI and G-computation to calculate the natural direct and indirect effects. Results: A total of 60,202 individuals were evaluated. Women had higher prevalences of major depressive episode (OR = 2.36; 95%CI 2.03-2.74), suicidal ideation (OR = 2.02; 95%CI 1.73-2.36) and violence victimization (OR = 1.73; 95%CI 1.45-2.06). The mediation analysis showed that 10.6% of the association between sex and major depressive episode and 8.0% of the association between sex and suicidal ideation is explained by violence. Conclusions: Women in Brazil have an increased risk of major depressive episode and suicidal ideation, and this association is mediated, in part, by the fact that they suffer more violence from family members or acquaintances.

Estudios de cohortes especiales / Special cohort studies

Resumen Como se comentó en el artículo anterior (Estudios de cohortes. 1ª parte. Descripción, metodología y aplicaciones), los estudios de cohortes se caracterizan por ser observacionales, longitudinales y analíticos; y en todos ellos se debe considerar una exposición o "factor de exposición", un período de seguimiento, eventuales pérdidas de seguimiento y el desenlace de un resultado. Se han propuesto modificaciones y variantes al diseño del estudio de cohortes tradicional. Se describen de forma resumida, las características principales de los estudios de cohortes con base poblacional, de cohortes bidireccional o ambispectivo; y de otras variantes: según número de cohortes (única y múltiple), de acuerdo al tipo de reclutamiento de la población a estudio (cerrada y abierta), según el tipo de exposición (fija y dinámica); estudio de casos y controles anidado, cohorte-caso; y cohortes ocupacionales (simple con población de referencia externa, simple con grupo de referencia interna y de cohortes múltiples). Finalmente, se desarrollan algunos ejemplos de la literatura de las variantes de cohortes más frecuentes. El objetivo de este manuscrito fue generar un documento de estudio referente a las modificaciones y variantes del diseño del estudio de cohortes.

As we mentioned in a previous article (Cohort studies. 1st part. Description, methodology and applications), cohort studies are characterized by being observational, longitudinal and analytical studies; and in all of them an exposure, a follow-up period, eventual loss of follow-up; and an outcome should be considered. A number of modifications and variants to the traditional cohort study design have been proposed. A summary with the main characteristics of population-based cohort studies, bidirectional cohorts, and of other variants according: to the number of cohorts (single and multiple), to the recruitment of the study population (closed and open), to the exposure (fixed and dynamic); nested case-control study, cohort-case, and occupational cohorts (simple with external reference population, simple with internal reference group and multiple cohorts), are described. Finally, examples of the literature of the most frequent cohort variants are developed. The aim of this manuscript was to generate a study document referring to some of the modifications and variants of cohort studies.

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Disability and post-trauma stress in the population over 15 years old in Kashan, Iran: A population-based study / 中华创伤杂志(英文版)

PURPOSE@#One of the consequences of trauma-related injuries is disability. There are more than one billion people with disabilities worldwide. Disability in people reduces their quality of life. The goal of this study was to determine the rate of post-trauma stress and disability related to trauma in the population over 15 years old in Kashan during a solar year of 2018-2019.@*METHODS@#This is a cross-sectional population-based study. A cluster sampling method was used in the city of Kashan, and 3880 persons were interviewed with individuals randomly selected in each household. If a person had trauma during one year ago, the World Health Organization Disability Assessment Schedule 2.0 and Post Trauma Stress Disorder (PTSD) Checklist were applied for further interview. Data were analyzed using Chi-square test or t-test.@*RESULTS@#Among the 3880 participants residing in Kashan, 274 (7.1%) reported a history of traumatic injury during one year ago in 2018-2019. Incidence of all injuries was estimated to be 70.61 (62.60-78.70) per 1000 people. For the trauma population, 213 (77.7%) were male and 75.1% were married. About half of them (50.3%, 138/274) aged 21-39 years. The most common cause of injuries was related to traffic accidents: 140 (51.1%). Of the 274 trauma participants, 47 (17.2%) reported PTSD; 244 (89.1%) had a mild disability, and 30 (10.9%) reported moderate disability.@*CONCLUSION@#One of the main causes of disability in the human community is the traumatic injuries. According to the results of this study, 89.1% of trauma participants have sustained at last mild disability following trauma. These people require follow-up and post-treatment support. It should be noted that psychological complications such as PTSD are as significant as physical symptoms.

Arterial Stiffness Is Not Independently Associated With Nighttime Sleep Duration In Community-Dwelling Older Adults. Results From The Atahualpa Project / La Rigidez Arterial No Se Encuentra Asociada Con La Duración Del Sueño Nocturno En Adultos Añosos Que Viven En La Comunidad. Resultados Del Proyecto Atahualpa

ABSTRACT Objectives: We aimed to assess the association between arterial stiffness and nighttime sleep duration in community-dwelling older adults living in rural Ecuador. Methods: Aortic pulse wave velocity (PWV) determinations were used to assess arterial stiffness. Nighttime sleep duration was assessed by a single question. A generalized linear model - adjusted for demographics, cardiovascular risk factors and psychological distress - was fitted to assess the independent association between the aortic PWV and nighttime sleep duration (dependent variable). Results: A total of 303 individuals were enrolled. Univariate analysis showed a significant association between the aortic PWV and long sleep duration (p=0.034), which vanished in a multivariate linear model (p=0.524). The single covariable remaining significant was anxiety (p=0.013). Conclusion: Lack of independent association between arterial stiffness and nighttime sleep duration might be more likely related to lack of reliability of evaluation of sleep duration by means of a single question.

RESUMEN Objetivos: En el presente estudio se evaluó la asociación entre rigidez arterial y duración del sueño nocturno en adultos mayores que viven en la comunidad en una zona rural de la costa Ecuatoriana. Métodos: Se utilizaron determinaciones de velocidad de onda de pulso aórtico (PWV) para evaluar la rigidez arterial. La duración del sueño nocturno se evaluó mediante una sola pregunta. Un modelo lineal generalizado, ajustado por variables demográficas, factores de riesgo cardiovascular y distress psicológico, evaluó la asociación independiente entre el PWV aórtico y la duración del sueño nocturno (variable dependiente). Resultados: Se registraron un total de 303 individuos. El análisis univariado mostró una asociación significativa entre el PWV aórtico y larga duración del sueño (p=0.034), que desapareció en un modelo lineal multivariado (p=0.524). La única covariable que permaneció significativa fue la ansiedad (p=0.013). Conclusión: La falta de asociación independiente entre rigidez arterial y duración del sueño nocturno podría estar relacionada con la falta de confiabilidad de la evaluación de la duración del sueño mediante una sola pregunta.

Longitudinal analysis of laboratory tests in a population-based study / Análise longitudinal da qualidade dos exames laboratoriais em um estudo de base populacional

ABSTRACT Clinical laboratories must have quality management systems that guarantee the reliability of their results. Furthermore, in longitudinal studies, it is important that the generated data be analyzed over time, as an additional measure of quality control (QC), seeking to identify fluctuations not explainable by biological variables. Applying this strategy to the SHIP-Brazil study was the aim of this work. Thus, we analyzed the results of fasting glucose, post-load glucose and glycated hemoglobin in the participants of the SHIP-Brazil study, from July 2014 to November 2016, in relation to the following aspects: difference of each individual's results from the mean of the month over time, mean and median of results over time, and percentage of results above the reference values over time, with trend line. According to the observed data, in order to guarantee the correct association of laboratory parameters with different health and disease conditions, the fasting blood glucose and post-load glucose measurements in the samples collected during the first months of the study are consistent, despite being performed in two different facilities. This QC strategy has proved very useful, and may even be used by clinical laboratories in their routine, observing result fluctuations of their population in the course of time, being capable of eventually detect bias even before the routine practices of internal and external quality control.

RESUMEN Los laboratorios clínicos deben tener sistemas de gestión de calidad que garanticen la fiabilidad de los resultados. Además, en estudios longitudinales, es importante que los datos generados sean analizados a lo largo del tempo, como medida adicional de control de calidad (QC), buscando identificar fluctuaciones no explicables por variables biológicas. Aplicar esa estrategia al estudio SHIP-Brasil es el objetivo de este trabajo. Analizamos los resultados de glucemia en ayunas, prueba de sobrecarga de glucosa y hemoglobina glucada en los participantes del estudio SHIP-Brasil, en el período de julio de 2014 a noviembre de 2016, acerca de los siguientes aspectos: diferencia de los resultados de cada individuo con respecto a la media del mes con el tiempo; media y mediana de los valores con el tiempo; y porcentaje de resultados por encima de los valores de referencia con el tempo, con línea de tendencia. Según los datos observados, las mediciones de glucemia en ayunas y tras una sobrecarga de glucosa, en las muestras recolectadas en los primeros meses de estudio, resultan consistentes, a pesar de haber sido realizadas en dos laboratorios distintos. Esa estrategia de QC se presentó muy útil y puede, incluso, ser utilizada por laboratorios clínicos en su rutina, observando fluctuaciones de resultados de su población a lo largo del tiempo, detectando, eventualmente, desviaciones aún antes de las prácticas rutinarias de control interno y externo de calidad.

RESUMO Os laboratórios clínicos devem ter sistemas de gestão da qualidade que garantam a fidedignidade dos resultados. Ainda, em estudos longitudinais, é importante que os dados gerados sejam analisados ao longo do tempo, como medida adicional de controle de qualidade (CQ), buscando identificar flutuações não explicáveis por variáveis biológicas. Aplicar essa estratégia ao estudo SHIP-Brasil foi o objetivo deste trabalho. Analisamos os resultados de glicemia em jejum, glicemia pós-sobrecarga e hemoglobina glicada nos participantes do estudo SHIP-Brasil, no período de julho de 2014 a novembro de 2016, em relação aos seguintes aspectos: diferença dos resultados de cada indivíduo em relação à média do mês ao longo do tempo; média e mediana dos valores ao longo do tempo; e porcentagem de resultados acima dos valores de referência ao longo do tempo, com linha de tendência. De acordo com os dados observados, as dosagens de glicemia em jejum e glicemia pós-sobrecarga, nas amostras coletadas nos primeiros meses de estudo, apresentam-se consistentes, mesmo tendo sido realizadas em dois laboratórios distintos. Essa estratégia de CQ mostrou-se bastante útil e pode, inclusive, ser utilizada pelos laboratórios clínicos em sua rotina, observando as flutuações de resultados de sua população ao longo do tempo, detectando, eventualmente, desvios antes mesmo das práticas rotineiras de controle interno e externo da qualidade.

Assessment of quality of life among stroke survivors: a longitudinal study

Background: Quality of life (QoL) among stroke survivors is a concern which has not received sufficient attention in India. The objective of the study was to assess the quality of life of stroke survivors in rural population of Chikkaballapur district, Karnataka.Methods: A community based longitudinal study was done amongst the 150 incident stroke cases registered during the period from March 2013 to November 2014 and who survived beyond 28 days. The cases were enrolled and interviewed using a semi-structured questionnaire and were followed up for 6th month period. QoL was assessed at baseline (at 28 days), at 3rd month and 6th Month using Stroke Specific QoL scale (SSQoL) and Barthel index (BI).Results: The mean age of the persons with stroke was 61.3±15 years with a majority being males (69.3%). Baseline median score (IQR) of SSQoL at 28th day was poor i.e. 131 (77-183). Among the 150 cases, 136 (91%) survived until the end of 6th month. The overall QOL gradually improved to 182 (133-213) and 185 (147-213) at 3rd and 6th month respectively and similar improvement was seen individually in physical, psychological and social domains as well and on multivariate logistic regression age <60 years and few disturbed consciousness among the stroke survivors during the 6th month follow up were found to be predictors for improved quality of life.Conclusions: QoL showed significant improvements in all physical, psychological and social domains by the end of the 6th month of follow up.

Recurrence Rate of Herpes Zoster and Its Risk Factors: a Population-based Cohort Study

BACKGROUND: Herpes zoster (HZ) is generally thought to occur once in a lifetime and recurrence is considered to be limited to immunocompromised individuals. Although HZ recurrence rates seem to be increasing, there have been few studies exploring these rates in the general population. We investigated the recurrence rate and associated risk factors in the general population. METHODS: We used the population-based samples of the National Health Insurance Service database to identify cases of initial HZ episodes from January 1, 2002 to December 31, 2013. We also followed up on these cases through December 31, 2013 to identify recurrence. RESULTS: Overall, the incidence rate of HZ is 5.1 per 1,000 person years and the recurrence rate is 12.0 per 1,000 person years. There were 2,100 recurrent cases out of 39,441 initial episodes with 4.4 years of the mean follow-up period. We identified significant risk factors for recurrence such as old age (51–70 years) (hazard ratio [HR], 1.447; 95% confidence interval [CI], 1.311–1.598), women (1.476; 1.345–1.619), zoster-related pain (ZRP) longer than 30 days (cases of ZRP lasting 31–90 days [1.200; 1.042–1.383], and ZRP lasting longer than 90 days [2.293; 1.990–2.643]). Concurrent hematologic malignancies (2.864; 1.929–4.251), autoimmune diseases (1.466; 1.252–1.715), dyslipidemia (1.390; 1.263–1.530), and hypertension (1.222; 1.107–1.350) were also significant risk factors. CONCLUSION: Our results suggest that the recurrence of HZ is much more common than generally expected, and that the associated risk factors can play an important role in predicting recurrence.

Uso de complexo homeopático reduz o parasitismo por carrapatos e amplia o intervalo de tempo entre tratamentos com acaricidas / Homeopathic complex decreases tick parasitism and increases the interval between treatments with acaricides

O presente trabalho avaliou a segurança e eficácia de 2 formulações homeopáticas no tratamento populacional de bovinos naturalmente parasitados com carrapatos da espécie Rhipicephalus (Boophilus) microplus. Foram realizados 2 experimentos utilizando complexos homeopáticos distintos, ambos com 20 vacas adultas, raça holandesa, em diferentes estágios de lactação, distribuídas em grupo controle (n= 10) e grupo tratado (n= 10) num estudo randomizado com duplo cego. A contagem de carrapatos foi registrada nos dias 7, 14, 21 e 28 após o tratamento homeopático e, posteriormente, em intervalos de 15 dias até o dia 140 do Experimento 01 e o dia 197 do Experimento 02. A formulação homeopática utilizada no Experimento 01 apresentou eficácia de 21,1%, sendo necessária intervenção com tratamento convencional durante o período de 140 dias. A eficácia do complexo homeopático no Experimento 02 foi de 6,7%. Os resultados foram seguros e eficazes na terapia antiparasitária, tendo bons resultados quando complementados com o uso racional e correto de acaricidas. (AU)

In the present study evaluated the efficacy of 2 homeopathic formulas in the treatment of cattle naturally with Rhipicephalus (Boophilus) microplus ticks. Two experiments were carried out using different combinations of homeopathic medicines, with 20 adult Holstein cows, in different stages of lactation, allocated to the control (n= 10) and treated (n= 10) groups in a randomized double-blind placebo-controlled trial. Tick count was performed on days 7, 14, 21 and 28 after homeopathic treatment ,and then at 15-day intervals up to day 140 in Experiment 1 and day 197 in Experiment 2. Efficacy in Experiment 1 was 21.1%, while conventional intervention was required along the 140-day period. Efficacy in Experiment 2 was 6.7%. The results indicate that the tested homeopathic formulas were safe and efficacious, outcomes being satisfactory when homeopathic treatment was combined with rational and correct conventional treatment. (AU)

Interpretation for the group standards in technical specification of long-term follow-up for end point in large population-based cohort study / 中华流行病学杂志

Long-term follow-up for end point is an extremely important and arduous task in large population-based cohort studies, which is also the key to the success of large cohort studies. Thus, the fundamental question of the achievements above is how to construct a large population- based cohort in a standardized way. The Chinese Preventive Medicine Association coordinated experienced researchers from Zhejiang Provincial Center for Disease Control and Prevention and other professional institutes to write up the group standard entitled Technical specification of long-term follow-up for end point in large population-based cohort study (T/CPMA 002-2019). The standard is drafted with principles of emphasizing the scientific, normative, applicability, and feasible nature. This group standard recommended the follow-up target population, time, content, methods, quality control, and indicators assessment. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence, to improve domestic scientific research level and the international influence, and to support decision-making and practice of disease prevention and control.

Interpretation for the group standards in technical specification of management for field survey in large population-based cohort study / 中华流行病学杂志

Large population-based cohort study is an important resource for population disease prevention and control, the results of which provide scientific basis for individualized treatment and precise prevention, and it is also the key strategic content of precision medicine. The Chinese Preventive Medicine Association coordinated experienced researchers from the Chinese Academy of Medical Sciences and other professional institutes to write up the group standard entitled Technical specification of management for field investigation in large population-based cohort study (T/CPMA 001-2019). Based on the research of large population-based cohort study in China and the principle of scientific, normative, applicable, and feasible, the standard proposed six aspects of management requirements including institutional arrangement, personnel composition, equipment, materials, documents and finance, as well as the basic requirements of the on-site investigation, the requirements of each position and the overall quality control requirements, etc.. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence to improve scientific research level, accelerate scientific research output and provide localization basis for disease prevention and control in China.