Preliminary estimation of lung cancer risk of radon exposure in a uranium mine using different corrections / 中国职业医学

Objective: To explore the correction factors of lung cancer caused by radon exposure in a uranium mine, and estimate the excess relative risk (ERR) coefficient of lung cancer caused by radon in the uranium miners. Methods: Male miners who worked in a uranium mine more than one year in Hunan Province from 1958 to 2018 were selected. This study preliminarily estimated the ERR coefficient of lung cancer caused by radon in the miners with different corrections using the Possion regression model. Results: This study cohort included 4 851 uranium miners, with 187 miners died with lung cancer from 1958 to 2018, and cumulative follow-up of 207 251 person-year. The ERR coefficient of lung cancer caused by radon without correction factors was estimated to be 0.21%/WLM (95%CI: 0.04%/WLM-0.27%/WLM). In the final model, the exponential correction factors of radon-induced lung cancer were time since exposure and exposure rate. In this model, if time since exposure was 45 years and the average exposure rate was 0.14 WL, the estimated ERR coefficient was 1.73%/WLM (95%CI: 0.36%/WLM-3.11%/WLM). The ERR decreases by about 60.00% for every 10 years since exposure, and increases by about 30.00% for every one WL increase exposure rate. Conclusion: The correction factors of lung cancer caused by radon in uranium miners in this mine were the time since exposure and exposure rate. It was preliminarily estimated that the ERR coefficient of lung cancer caused by radon in the occupational radon exposed population in this uranium mine was 1.73%/WLM (95%CI: 0.36%/WLM-3.11%/WLM).

Study on the effect of temperature on the risk of hand, foot and mouth disease in Chengdu / 公共卫生与预防医学

Objective To explore the effect of temperature on the risk of hand-foot-and-mouth disease (HFMD) and population susceptibility. Methods The data of HFMD cases in Chengdu from January 1, 2016 to October 31, 2022 were collected, and local meteorological data during the same period were also collected. Distributional lag nonlinear models were developed. The relative risk (RR) of morbidity at different temperatures and different lags was calculated. Differences in the relative risk levels of different populations were analyzed and compared. Results A total of 263 776 cases of HFDM were reported in Chengdu during the study period. The distribution of HFMD was periodic. For the overall population, the short-term average temperature and RR showed a “U”-shaped relationship. When the lag time was 0-7 days, the cumulative RR was 1.59 (95%CI: 1.18-2.14) at the average temperature of -0.5℃ and 2.16 (95%CI: 1.60-2.91) at the average temperature of 34.5℃. The RR values under high and low temperatures decreased with increasing lag period. When the lag time was extended, the average temperature and RR showed an inverted “U”-shaped relationship, with higher RR at moderate temperatures and increasing as the lag period increased. The results of the subgroups showed that the RR of onset among scattered children was higher at high and low temperatures. Conclusion The risk effect of temperature on the onset of HFMD in different populations is variable and changes with the lag period, and the prevention and control measures should be adjusted in a timely and targeted manner.

The cancer risk and epidemiological analysis for medical X-ray workers in Shanghai / 中华放射医学与防护杂志

Objective:To study the risk of malignant tumor in medical X-ray workers in Shanghai and provide scientific data for the study on occupationally exposed population.Methods:A retrospective cohort study was conducted to investigate the risk of cancer. Totally, 715 physicians in radiology departments during 1950-1980 in Shanghai were selected as exposure group, while 738 with non-radiology departments in the same hospital in the same time period as control group. The basic information on the selected physicians and associated cancer incidence were collected. The comulative number of individuals with cancer from 1980 to 2021 was calculated. The relative risk ( RR) of cancer was analyzed using logistic regression model in terms of gender, birth year, and work starting year. As well, stratified analysis based on confounding factors was conducted. Results:A total of 1 369 individuals were followed up, including 668 in exposure group and 701 in control group. The cumulative person-year of observed individuals was 52 980. As of 31 December 2021, a total of 199 patients with various malignant tumors were identified. The results of the logistic regression analysis showed that the risk of malignant tumors in exposure group was significantly higher than that in control group. The adjusted RR of solid cancer and total cancer was 1.49 (95% CI: 1.08-2.05, P=0.015) and 1.40 (95% CI: 1.02-1.92, P=0.036), respectively. In addition, the risk of thyroid cancer in exposure group was significantly higher than that in control group ( RR=10.06, 95% CI: 2.05-49.62, P=0.005). Stratified analysis showed that the exposure group had a higher risk of total cancer both for femals and workers taking their jobs at age of 21-25. Conclusions:The risk of thyroid cancer, solid cancer and total cancer in the medical X-ray workers was significantly higher than that in control group. It is suggested that radiation protection in medical practice should be strengthened for the occupationally exposed workers, especially for femals and workers taking their jobs at low age.

Study Design: Observational Studies

Observational study designs are those where the investigator/researcher just observes and does not carry out any intervention(s)/actions to alter the outcome. The three most common types of observational studies are cross-sectional, case control and cohort (or longitudinal). In cross-sectional studies, both the exposure/risk factor(s) and the outcome(s) are determined at a single time point. They can provide information on prevalence of a condition and snapshot of probable associations that can be used to generate hypothesis. Case-control studies are where subjects are selected based on presence/absence of outcome and the risk factors are determined during the study after enrolment of study subjects. The association between exposure and outcome is reported as odds ratio. These studies; however, have high risk of bias, which must be taken care of during study design. Cohort studies are prospective in nature, where subjects are selected based on presence/absence of exposure, and the outcome(s) is determined at the end of study. These studies can provide incidence of disease/outcome and the association between exposure and outcome is reported as relative risk. They are useful to ascertain causality. High dropouts of study participants and confounding can be problems encountered in these studies. Keywords: Case-control, Cohort, Cross-sectional, Odds ratio, Relative risk, Survey

Análisis de la curva ROC en la evaluación de indicadores antropométricos / Analysis of the ROC curve in the evaluation ofanthropometric indicators

Evaluación del Índice Peso-Circunferencia de Cintura (IPCC) mediante Regresión Logística. Estudio descriptivo, prospectivo y transversal, muestra 1095 adultos y adultos mayores, edad entre 20 y 96 años. Métodos: variables: edad, peso, talla, Circunferencia de Cintura (CC), IMC, Índice Cintura-Talla (ICT). Resultados: IMC similar en los dos sexos; promedios de CC e ICT mayor en grupo ≥ 65 años; IPCC mayor en grupo 20-59 años; porcentaje de riesgo del IPCC(54,1%) mayor en CC (44,7%) menor en ICT (78,2%). IPCC significativamente asociado al IMC, CC e ICT (p<0,000); valor predictivo positivo 0,92 y valor predictivo negativo 0,70, indican capacidad discriminativa; Riesgo Relativo, 1,92; el estadístico de prueba Wald indica significancia estadística para los coeficientes de ecuaciones de probabilidad de riesgo; área bajo la curva ROC es 0,803 y 0,903 (P<0,000), alta sensibilidad y especificidad. Conclusión: el IPCC puede considerarse para evaluar sobrepeso y obesidad en adultos, dada su alta capacidad discriminativa(AU)

Evaluation of the Waist Weight-CircumferenceIndex (WWCI) using Logistic Regression. Descriptive, prospective and cross-sectional study shows 1095 adults andolder adults, aged between 20 and 96 years. Methods: variables: age, weight, size, Waist Circumference (WC), BMI, Waist-SizeIndex (WSI). Results: Similar BMI in both sexes; higher WCand WSI averages in a ≥ age of 65; major WWCI in group20-59 years; WWCI risk rate (54.1%) higher in WC (44.7%)WSI (78.2%). WWSI significantly associated with BMI, WCand WSI (p<0.000); positive predictive value 0.92 and negative predictive value 0.70, indicate discriminatory capacity; RelativeRisk, 1.92; Wald test statistic indicates statistical significance for the coefficients of risk probability equations; area under theROC curve is 0.803 and 0.903 (P<0.000), high sensitivity and specificity. Conclusion: WWCI can be considered to evaluate overweight and obesity in adults, given its high discriminatory capacity(AU)

Analysis of causal mediation effect with odds ratio and excess relative risk as evaluation indexes / 四川精神卫生

The purpose of this paper was to introduce how to set the options of variable levels and multimodal covariates， and to demonstrate the causal mediation effect analysis method with odds ratio （OR） and excess relative risk （ERR） as evaluation indicators through examples. For treatment variables， mediator variables and covariates， the variable-level options of them could be set through the evaluate statement. For categorical variables and their interaction terms， they could be treated as multimodal covariates， and the variable levels could also be set for them by using the evaluate statement. Through an example， this paper used SAS to realize the causal mediation effect analysis and the decomposition of effect components with OR and ERR as the evaluation indicators.

Utilizing prospective space-time scan statistics to discover the dynamics of coronavirus disease 2019 clusters in the State of São Paulo, Brazil

ABSTRACT Background: The number of deaths and people infected with coronavirus disease 2019 (COVID-19) in Brazil has steadily increased in the first few months of the pandemic. Despite the underreporting of coronavirus cases by government agencies across the country, São Paulo has the highest rate among all Brazilian states. Methods: To identify the highest-risk municipalities during the initial outbreak, we utilized daily confirmed case data from official reports between February 25 and May 5, 2020, which were aggregated to the municipality level. A prospective space-time scan statistic was conducted to detect active clusters in three different time periods. Results: Our findings suggest that approximately 4.6 times more municipalities belong to a significant space-time cluster with a relative risk (RR) > 1 on May 5, 2020. Conclusions: Our study demonstrated the applicability of the space-time scan statistic for the detection of emerging clusters of COVID-19. In particular, we identified the clusters and RR of municipalities in the initial months of the pandemic, explaining the spatiotemporal patterns of COVID-19 transmission in the state of São Paulo. These results can be used to improve disease monitoring and facilitate targeted interventions.

Fifth epidemiological investigation on tumor prevalence among medical X-ray workers in Chongqing, China / 中国辐射卫生

Objective To provide scientific data for the study of tumor prevalence among medical X-ray workers. Methods In a cohort study, radiation exposure and tumor occurrence were collected from medical X-ray workers and normal persons (control) in Chongqing, China. SPSS 24 software was used to calculate the incidence density of tumor in the follow-up cohort, as well as the relative risk (RR) and 95% confidence interval of various malignant tumors. Results A total of 934 subjects were followed up. By the end of the investigation, 109 cases of malignant tumor were recorded. Compared with the control group, the RRs of liver cancer and colorectal cancer were both 3.4. Dose-specific RR was calculated for the worker groups. Compared with the two groups with < 80 mGy and 80～200 mGy cumulative doses, the group with > 200 mGy cumulative dose showed 2.05 and 2.1 RRs for solid cancer, and 1.89 and 2.17 RRs for whole cancer, respectively. Conclusion The risk of liver cancer and colorectal cancer is higher for medical X-ray workers in Chongqing, and the risk of solid cancer and whole cancer is higher in the high cumulative dose group. Therefore, radiation workers should pay attention to the optimization of protection.

Risk assessment models of radon-induced lung cancer and their preliminary application / 中华放射医学与防护杂志

Radon is the second largest environmental factor inducing lung cancer after smoking. In recent years, with the deeper epidemiological investigation on radon and lung cancer and the further improvement of its methodology, new progress has been made in the research on risk assessment models. This paper reviews the relative risk models of radon-induced lung cancer developed by several international academic organizations or research teams, and briefly introduces the background information on the models and the main factors considered. Based on the indoor radon concentrations in different decades in China, the relative risks of radon-induced lung cancer were estimated and analyzed, together with some suggestions given for more accurate evaluation of lung cancer induced by indoor radon in the future.

Study on non-cancer incidence among medical radiation workers in Chongqing / 中华放射医学与防护杂志

Objective:To study the effect of occupational X-ray exposure on non-cancer diseases of radiation workers.Methods:The medical X-ray workers in Chongqing mumicipality were surved in 1980. In 2020, the previous 91 medical institutions distributed across 41 districts and counties of Chongqing continued to be selected as the survyed units, including 53 grade-A top-class hospitals. Using the method of prospective cohort study, the fifth follow-up survey was conducted for Chongqing′s medical X-ray workers and the control groups in 1980 with respect to their personal information, occupational radiation exposure, disease history and others. The incidence rate, relative risk ( RR) and 95% confidence interval of diseases in each system were analyzed. Results:There were 937 individuals in this cohort. So far, 359 cases of non-cancer diseases had been counted. Compared with the control group, the relative risk RR of cardiovascular system, ophthalmology and other unclassified diseases in the exposure group were 1.50, 2.03 and 2.64 ( χ2=5.97, 3.97, 4.25, P <0.05) , respectively. The adjusted confounding factors showed that the RR of the incidence rate of cardiovascular, ophthalmic and digestive diseases in the female exposure group was generally higher than that in the control group ( RR=2.33, 2.59, 7.55; χ2= 7.28, 4.17, 8.64, P < 0.05) , respectively. The RR of the incidence rate of cardiovascular and ophthalmic diseases in exposure group was generally higher than that in the control group among 25-29 year-old workers ( RR=2.26, 5.07; χ2 =8.22, 4.91, P < 0.05) , respectively. For compasion between the the accumulated dose groups, the incidence rate of cardiovascular system, ophthalmology and digestive system diseases in the exposure group was generally higher than that in the control group ( RR=1.86, 2.91, 3.59; χ2= 9.83, 8.21, 5.58, P < 0.05) , respectively. Conclusions:The non-cancer risk of X-ray workers exposed to long-term occupational exposure was increased, among which the risk of cardiovascular system, digestive system, ophthalmic diseases and others might be related to the occupational exposure.

Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study / Fatores de risco associados à ruptura uterina e deiscência: Um estudo transversal canadense

Abstract Objective To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence. Methods Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada. Results There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p=0.02), elevated maternal body mass index (BMI; OR: 3.4; p=0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p=0.05) and 5-minute low Apgar score (OR: 5.9; p<0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p=0.006), postpartum hemorrhage (OR: 13.9; p<0.001), hysterectomy (OR: 23.0; p=0.002), and stillbirth (OR: 8.2; p<0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight. Conclusion This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.

Resumo Objetivo Comparar os fatores de risco maternos e perinatais associados à ruptura uterina completa e deiscência uterina. Métodos Estudo transversal de pacientes com ruptura/deiscência uterina no período de janeiro de 1998 a dezembro de 2017 (30 anos) internadas na Unidade de Parto de um hospital universitário terciário no Canadá. Resultados Ocorreram 174 (0,1%) casos de transtorno uterino (29 rupturas e 145 deiscências) em 169.356 partos. Houve associações entre deiscência e multiparidade (razão de chances [RC]: 3,2; p=0,02), índice demassa corporal (IMC)materno elevado (RC: 3,4; p=0,02), tentativa de parto vaginal após cesariana (RC: 2,9; p=0,05) e baixa pontuação Apgar em 5minutos (RC: 5,9; p<0,001). A ruptura uterina foi associada a partos prematuros (36,5 ± 4,9 versus 38,2 ± 2,9; p=0,006), hemorragia pós-parto (RC: 13,9; p<0,001), histerectomia (RC: 23,0; p=0,002) e natimorto (RC: 8,2; p<0,001). Não houve associação entre ruptura uterina e idade materna, idade gestacional, início do trabalho de parto, ruptura espontânea ou artificial de membranas, uso de ocitocina, tipo de incisão uterina e peso ao nascer. Conclusão Esta grande coorte demonstrou que existem diferentes fatores de risco associados à ruptura ou à deiscência uterina. A ruptura uterina ainda representa uma grande ameaça à saúde materno-fetal e, diferentemente da crença comum, a deiscência uterina também pode comprometer os desfechos perinatais.

Mortalidad entre Jóvenes Inmigrantes Nicaragüenses en Costa Rica, 2000-2017 / Mortality of young Nicaraguan inmigrants in Costa Rica during the 2000-2017 period

Introducción: La pobreza, discriminación y el aislamiento social, son elementos que afectan a las personas inmigrantes nicaragüenses residentes en Costa Rica, condiciones que pueden afectar las tasas de mortalidad observada en esta población migrante. Objetivo: Determinar las tasas de mortalidad por enfermedades y causas externas en población joven inmigrante nicaragüense y nativos costarricenses en Costa Rica. Materiales y métodos: Con la información de defunciones entre el año 2000 y 2017 y la población del Censo 2011 se calcularon tasas de mortalidad y posteriormente el riesgo relativo (RR) de diferentes causas de mortalidad. Los resultados se compararon con un estudio que analizó este fenómeno entre 1998-2008. Resultados: El 64% de las defunciones de inmigrantes son por causas externas, versus el 57% de los locales. Con respecto a los datos de hace 10 años, hay una disminución de 2 puntos porcentuales de las defunciones por causas externas entre los inmigrantes. Los inmigrantes tienen RR mayores de mortalidad por causas externas (otros accidentes 1,85, homicidios 1,72, accidentes vehiculares 1,22 y suicidios 1,14). Se destaca una disminución de 0,27 y 0,15 del RR de los homicidios y alcoholismo. Conclusiones: Los patrones de mortalidad de los inmigrantes empiezan comportarse como el de la población costarricense.

Introduction: Poverty, discrimination, and social isolation are some elements that affect Nicaraguan immigrants residing in Costa Rica, conditions that have an impact on the mortality figures observed in this migrant population. Objective: To determine mortality rates caused by diseases and external reasons in both the young Nicaraguan immigrant population and native Costa Rican natives. Materials and methods: Data on deaths between 2000 and 2017 and the 2011 Census information of the Costa Rican population were used to calculate mortality rates and the relative risk (RR) associated with different causes of mortality. Results were compared to a study that analyzed this phenomenon between 1998-2008. Results: Compared to the deaths in the Costa Rican population (57%), 64% of deaths in immigrants are due to external causes. With respect to the data from 10 years ago, there is a 2-percentage point reduction in deaths of immigrants caused by external reasons. Immigrants show higher RRs of mortality due to external causes (other accidents 1.85, homicides 1.72, car accidents 1.22, and suicide 1.14). A reduction of 2.27 and 0.15 in the RR of homicides and alcoholism, respectively, is highlighted. Conclusions: Mortality patterns in immigrants begin to behave as those of the Costa Rican population.

How to use χ2 test correctly—— χ2 test for the data of four-fold tables collected from the cohort design / 四川精神卫生

The purpose of this paper was to introduce the χ2 test for the data of four-fold tables collected from the cohort design， the hypothesis test and interval estimation of relative risk， and the implementation of SAS and R software. In view of the characteristics of cohort design， the concept of relative risk， hypothesis testing and interval estimation were emphasized. It was given that the interpretation of the results calculated by SAS and R software， as well as the statistical and professional conclusions.

How to use χ2 test correctly——the analysis of common relative risk for the data of a multiway table and the implementation of SAS software / 四川精神卫生

The purpose of the paper was to introduce the relative risk analysis method of g×2×2 table data and the calculation method based on SAS software. The contents included the following aspects： firstly， the homogeneity test of the data in the g×2×2 table was performed； secondly， when the data met the homogeneity requirements， the point estimation and confidence interval estimation of the common relative risk based on the correction method were implemented； thirdly， when the data did not meet the requirements of homogeneity， the common relative risk RRDL and its 95% confidence interval were estimated， based on the DerSimonian-Laird method （DL method for short）； fourthly， when the data met and did not meet the requirements of homogeneity， the hypothesis of "whether the common relative risk equals to 1" was tested. Combining two examples and based on SAS software， the paper completed the following three tasks： ① the homogeneity test for the relative risk； ② the point estimation of the common relative risk； ③the confidence interval estimation of the common relative risk. The last two tasks were performed under the conditions of the data met and did not meet the homogeneity requirements， respectively. The output results of SAS software were explained， and the statistical and professional conclusions were made.

Uterine vascular resistance and other maternal factors associated with the risk of developing hypertension during pregnancy

Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. The objective of the present study was to determine the increase in relative risk for developing hypertensive disorders of pregnancy based on the evaluation of pregnant women between 20 and 25 weeks of gestation, and to correlate the findings at this period with the outcome of pregnancy. We conducted a prospective cohort study, with a convenience sample of 1417 patients evaluated at this gestational age, of which 1306 were contacted at childbirth. We detected an increased relative risk of 2.69 (95%CI: 1.86 to 3.89) associated with pulsatility index of the uterine arteries, a 2.8 increase (95%CI: 1.58 to 5.03) in relative risk attributed to maternal age above 35 years, a 1.68 increase (95%CI: 1.17 to 2.40) attributed to parity greater than or equal to 3, and a 5.35 increase (95%CI: 4.18 to 6.85) attributed to chronic hypertension and obesity, with a progressive increase in relative risk according to the degree of overweight, i.e., grades 1, 2, 3, and morbid obesity (2.58, 3.06, 5.84, and 7.28, respectively).

Detección prospectiva espacio-temporal de conglomerados de COVID-19 en Cuba

RESUMEN Introducción: Durante enfermedades infecciosas emergentes en curso como la COVID-19, la vigilancia espacio-temporal es fundamental para identificar áreas prioritarias para intervenciones específicas, diferenciar intensidad diagnóstica y asignación de recursos. Objetivo: Modelar la evolución del riesgo relativo de presentación de casos de COVID-19 e identificar conglomerados en municipios donde la enfermedad se mantuvo en el periodo posterior al descenso de la curva epidémica en Cuba. Métodos: El periodo mencionado comprendió entre el 26/05/2020 hasta el 4/09/2020. Se realizaron corridas cíclicas del modelo prospectivo espacio-temporal de Poisson, con incrementos progresivos de 14 días, mediante la aplicación SaTScan™ 9.6. Resultados: Se identificaron 15 conglomerados significativos (p ≤ 0,0001) cuya extensión involucró desde uno hasta trece municipios, con distribución en seis provincias (Pinar del Río, Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara y Ciego de Ávila). En los conglomerados todos los municipios mostraron riesgo relativo alto, entre ellos, La Palma en la provincia de Pinar del Río y Ciego de Ávila en la provincia del mismo nombre, con los valores más altos, 119,95 y 121,04, respectivamente. Conclusión: El modelo empleado pudo identificar los conglomerados en territorios con significativa probabilidad de ocurrencia de COVID-19, así como periodos de evolución del riesgo relativo. Además, reconoce los municipios que merecen prioridad para intensificar en ellos intervenciones de contención y control sanitario y evitar la reemergencia de la enfermedad con mayor dispersión espacial.

ABSTRACT Introduction: During the occurrence of ongoing emerging infectious diseases such as COVID-19, spatiotemporal surveillance is crucial to identify priority areas for specific interventions, differentiate diagnostic intensity and assign resources. Objective: To model the evolution of the relative risk of presentation of COVID-19 cases and to identify clusters in municipalities where the disease remains at the stage following the descent of the epidemic curve in Cuba. Methods: The period mentioned was from 26/05/2020 to 4/09/2020. Cyclic runs of Poisson's prospective spatiotemporal model were performed, with progressive 14-day increases, using the software SaTScan™ 9.6. Results: A total 15 significant clusters were identified (p ≤ 0.0001) extending over one to thirteen municipalities and distributed in six provinces (Pinar del Río, Artemisa, Havana, Mayabeque, Matanzas, Villa Clara and Ciego de Ávila). In the clusters, all municipalities showed a high relative risk among them, La Palma in Pinar del Rio province and Ciego de Avila in the province of the same name, with the highest values, 119.95 and 121.04, respectively. Conclusion: The model was able to identify territories with a significant likelihood of COVID-19 occurrence, as well as periods in the evolution of relative risk. It also showed that surveillance and early warning strategies may facilitate prioritization of health control and containment interventions aimed at preventing the reemergence of the disease with greater spatial coverage.

Risk factors of malignant arrhythmia and predictive value of late ventricular potential in the patients with first episode depression disorder / 中华行为医学与脑科学杂志

Objective:To explore the risk factors of the incidence of arrhythmia and the prediction of baseline ventricular late potential in patients with first depression episode.Methods:The cohort study was used to observe the relationship between the baseline status of ventricular late potential, the severity of baseline depression symptoms, the extent of remission of depressive symptoms within the treatment duration and arrhythmia incidence in the 3 years progress. For the assessment of the severity of depression symptoms, 17 version of Hamilton depression scale was used to evaluate the baseline ventricular late potential, and DMS lab3.0 ECG platform late potential analysis system was used to determine the assessment (CardioScan 12 NET version). The first depression patients with positive ventricular late potential were followed up for 3 years. The changes of the severity of ventricular late potential and depression symptoms were investigated, and the correlation with the subsequent course of arrhythmia was investigated.SPSS 20.0 software package was used for statistical distraction, chi square test was used for count data, independent samples t test was used for normal distribution measurement data, Mann-Whitney U test was used for non-normal distribution count data, and logistic regression method was used to calculate relative risk( RR). Results:According to the 3-year follow-up of 400 first-episode depression patients, 22.25% (89/400) had malignant arrhythmia. The incidence of malignant arrhythmia was 39.46% (58/147) in ventricular late potential positive group and 12.25% (31/253) in ventricular late potential negative group, and the difference was statistically significant(χ 2=9.578, P<0.01). Logistic regression analysis showed that positive ventricular late potential at baseline (compared with negative ventricular late potential at baseline, RR=10.78, 95% CI=8.34-13.80), having a family history of arrhythmia (compared with no family history of arrhythmia, RR=5.23, 95% CI=2.41-9.85), had a higher severity of depression at baseline (compared with lower severity of depression at baseline, RR=1.73, 95% CI=1.25-2.85), poor first-time efficacy and more repeated hospitalizations (compared with good first-time efficacy and less hospitalizations, RR=1.11, 95% CI=1.04-1.17), and age of onset< 20 (compared with age of onset≥20, RR=1.07, 95% CI=1.02-1.93) were the risk factors of malignant arrhythmia in patients with first-episode depression(all P<0.05). Conclusion:The incidence of arrhythmia is very high in those patients with baseline positive late ventricular potential. Positive late ventricular potential, family history of arrhythmia, younger onset age and poor therapeutic effect were the relative risk of arrhythmia in the patients with depression.

Associations between floods and bacillary dysentery cases in main urban areas of Chongqing, China, 2005-2016: a retrospective study

BACKGROUND@#Understanding the association between floods and bacillary dysentery (BD) incidence is necessary for us to assess the health risk of extreme weather events. This study aims at exploring the association between floods and daily bacillary dysentery cases in main urban areas of Chongqing between 2005 and 2016 as well as evaluating the attributable risk from floods.@*METHODS@#The association between floods and daily bacillary dysentery cases was evaluated by using distributed lag non-linear model, controlling for meteorological factors, long-term trend, seasonality, and day of week. The fraction and number of bacillary dysentery cases attributable to floods was calculated. Subgroup analyses were conducted to explore the association across age, gender, and occupation.@*RESULTS@#After controlling the impact of temperature, precipitation, relative humidity, long-term trend, and seasonality, a significant lag effect of floods on bacillary dysentery cases was found at 0-day, 3-day, and 4-day lag, and the cumulative relative risk (CRR) over a 7-lag day period was 1.393 (95%CI 1.216-1.596). Male had higher risk than female. People under 5 years old and people aged 15-64 years old had significantly higher risk. Students, workers, and children had significantly higher risk. During the study period, based on 7-lag days, the attributable fraction of bacillary dysentery cases due to floods was 1.10% and the attributable number was 497 persons.@*CONCLUSIONS@#This study confirms that floods can increase the risk of bacillary dysentery incidence in main urban areas of Chongqing within an accurate time scale, the risk of bacillary dysentery caused by floods is still serious. The key population includes male, people under 5 years old, students, workers, and children. Considering the lag effect of floods on bacillary dysentery, the government and public health emergency departments should advance to the emergency health response in order to minimize the potential risk of floods on public.

Cáncer de mama en Jalisco. Análisis espacial de la mortalidad en 2010-2017 / Breast cancer in Jalisco: a spatial analysis of mortality in the 2010-2017 period

Resumen Introducción: En 2017, el INEGI reportó 84 142 defunciones por tumores malignos en México y la Organización Mundial de la Salud indicó que la tasa de mortalidad por cáncer de mama en 2018 fue de 11.2 por 100 mil mujeres. Objetivo: Mostrar la tendencia de la mortalidad por cáncer de mama en mujeres según municipio y región sanitaria de Jalisco en el periodo 2010-2017. Método: Estudio analítico en el que se estimaron tasas estandarizadas de mortalidad y riesgos relativos por municipio de residencia de 3873 mujeres. Se utilizó estadística espacial de dispersión y tendencia central. Resultados: La tasa de mortalidad aumentó de 10.7 a 13.0 por 100 mil mujeres en el periodo 2010-2017. Los valores más altos se encontraron en los municipios de Chapala (21.2) y Guadalajara (19.5), la tasa de mortalidad aumentó en cuatro de cada 10 municipios y el riesgo relativo fue hasta 50 veces mayor en algunos del occidente y centro de Jalisco. Conclusiones: Se observó un incremento de 1.0 % anual, aunque territorialmente diferenciado. Los resultados representan una oportunidad para mejorar los procesos de detección y diagnóstico oportunos, así como para garantizar la cobertura de los servicios.

Abstract Introduction: In 2017, INEGI reported 84,142 deaths from malignant tumors in Mexico, while the World Health Organization indicated that the breast cancer mortality rate in 2018 was 11.2 per 100,000 women. Objective: To show the trend of breast cancer mortality in women by municipality and health region of Jalisco in the 2010-2017 period. Method: Analytical study in which standardized mortality rates and relative risks of 3873 women were estimated by municipality of residence. Dispersion and central tendency spatial statistics were used. Results: The mortality rate increased from 10.7 to 13.0 per 100,000 women in the 2010-2017 period. The highest values were found in the municipalities of Chapala (21.2) and Guadalajara (19.5); the mortality rate increased in four out of every 10 municipalities, and relative risk was up to 50-fold higher in some of the western and central Jalisco municipalities. Conclusions: An annual increase of 1.0 % was observed, although it was territorially differentiated. The results represent an opportunity to improve timely detection and diagnostic processes, as well as to guarantee the coverage of services.

Las falacias de la p y significación estadística / The fallacies of P and statical significance

Resumen ANTECEDENTES: El valor de p es el método más empleado para estimar la significación estadística de cualquier hallazgo; sin embargo, en los últimos años se ha intensificado su debate al respecto, debido a la baja credibilidad y reproducibilidad de diversos estudios. OBJETIVO: Describir el estado actual del concepto del valor de p y la significación estadística (prueba de significación de la hipótesis nula [por sus siglas en inglés: Null Hypothesis Significance Testing: NHST]), especificar los problemas más importantes y puntualizar las soluciones propuestas para la mejor utilización de los conceptos. METODOLOGÍA: Se llevó a cabo la búsqueda bibliográfica en MEDLINE y Google Scholar, con los términos: "NHST", "Statistical significance; P value" en idioma inglés y español, de 2018-2019, limitándose a la selección de artículos publicados entre 2005 y 2019, mediante la revisión de tipo narrativo con búsqueda manual; sobre todo estudios de metodología. RESULTADOS: La búsqueda global reportó 1411 artículos: 875 de PubMed y 536 de Google Scholar. Se excluyeron 817 por duplicación, 155 sin acceso completo y 414 ensayos clínicos (sin metodología estadística); los 25 restantes fueron el motivo del análisis. CONCLUSIONES: El concepto del valor de p no es simple, tiene varias falacias y malas interpretaciones que deben considerarse para evitarlas en lo posible. Se recomienda no usar el término "estadísticamente significativo" o "significativo", sustituir el umbral de 0.05 por 0.005, informar valores de p precisos y con IC95%, riesgo relativo, razón de momios, tamaño del efecto o potencia y métodos bayesianos.

Abstract BACKGROUND: The P value is the most widely used method of estimating the statistical significance of any finding, however, in recent years the debate over the P value has been increasingly intensified due to the low credibility and reproducibility of many studies. OBJECTIVE: To describe the current state of the concept of the value of P and the statistical significance (Null Hypothesis Significance Testing (NHST), specify the most important problems and point out the solutions proposed in the literature for their best use. METHODOLOGY: Search in MEDLINE and Google Scholar, with the terms: "NHST", "Statistical significance; P value "in English and Spanish, carried out from 2018-2019, limited to articles published from 2005 to 2019, and a narrative-type review with manual search. Articles on methodology were preferably selected. RESULTS: The global search yielded 1411 articles, 875 from PubMed and 536 from Google Scholar. 817 were excluded by duplication, 155 without full access, 414 from clinical trials, without statistical methodology. The 25 selected articles were the reason for the analysis. CONCLUSIONS: The concept of the value of P is not simple, and it has several fallacies and misinterpretations that must be taken into account to avoid them as much as possible. Recommendations: Do not use "statistically significant" or "significant", replace the threshold of 0.05 with 0.005, report accurate P values with 95% CI, relative risk, odds ratio, effect size or power, and Bayesian methods.