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1.
Arq. bras. cardiol ; 116(5): 879-886, nov. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1248888

ABSTRACT

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. Resultados: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. Conclusão: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886)


Background: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. Objective: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. Methods: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. Results: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. Conclusion: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886)


Subject(s)
Humans , Male , Female , Aged , Obesity, Abdominal/complications , Body Mass Index , Likelihood Functions , Risk Factors , Waist-Hip Ratio , Waist Circumference , Middle Aged , Obesity/complications
3.
Gac. méd. Méx ; 157(1): 113-115, ene.-feb. 2021. tab
Article in Spanish | LILACS | ID: biblio-1279084

ABSTRACT

Resumen Introducción: Clostridioides difficile causa diarrea y colitis pseudomembranosa. Su diagnóstico se realiza con la detección de glutamato-deshidrogenasa (GDH) o las toxinas A y B y se confirma con pruebas de amplificación de ácidos nucleicos. Objetivo: Definir si la determinación de GDH es redundante a la de las toxinas. Métodos: Estudio observacional retrospectivo de muestras fecales de pacientes con sospecha de infección por Clostridioides difficile. Las toxinas y GDH se determinaron mediante inmunocromatografía. Se realizó una simulación bayesiana con los cocientes de probabilidad; se consideró significativo un valor de p < 0.05. Resultados: Se analizaron 329 resultados de GDH y toxinas A y B. Se encontró una prevalencia de infección de Clostridioides difficile de 18.2 %. La sensibilidad y especificidad de la prueba de GDH fue de 0.90 y 0.89, respectivamente. El cociente de probabilidad positivo fue de 8.9 y el negativo, de 0.11. Conclusiones: Un resultado negativo de GDH disminuye considerablemente la probabilidad de infección, pero no la descarta. La detección de toxinas de Clostridioides difficile puede ser necesaria en instituciones donde la amplificación de ácidos nucleicos no es económica o accesible.


Abstract Introduction: Clostridioides difficile causes diarrhea and pseudomembranous colitis. Its diagnosis is made with glutamate dehydrogenase (GDH) or toxins A and B detection and is confirmed with nucleic acid amplification tests. Objective: To define if GDH determination is redundant to that of toxins. Methods: Retrospective, observational study in diarrheal stools of patients with suspected Clostridioides difficile infection. Toxins and GDH were determined by immunochromatography. Bayesian simulation was performed with likelihood ratios; a p-value < 0.05 was regarded as significant. Results: 329 GDH and toxin A and B results were analyzed. Clostridioides difficile infection prevalence was 18.2 %. Sensitivity and specificity of the GDH test were 0.90 and 0.89, respectively. Positive likelihood ratio was 8.9, and negative was 0.11. Conclusions: A negative GDH result considerably reduces the probability of infection but does not rule it out. Clostridioides difficile toxins detection may be necessary in institutions where nucleic acid amplification is not affordable or accessible.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Bacterial Proteins/analysis , Bacterial Toxins/analysis , Clostridioides difficile , Clostridium Infections/diagnosis , Enterotoxins/analysis , Feces/chemistry , Biomarkers/analysis , Likelihood Functions , Prevalence , Retrospective Studies , Bayes Theorem , Sensitivity and Specificity , Clostridium Infections/epidemiology , Diarrhea/microbiology , Feces/enzymology , Glutamate Dehydrogenase/analysis
4.
Article in English | WPRIM | ID: wpr-785804

ABSTRACT

Isolation-with-migration (IM) models have become popular for explaining population divergence in the presence of migrations. Bayesian methods are commonly used to estimate IM models, but they are limited to small data analysis or simple model inference. Recently three methods, IMa3, MIST, and AIM, resolved these limitations. Here, we describe the major problems addressed by these three software and compare differences among their inference methods, despite their use of the same standard likelihood function.


Subject(s)
Bayes Theorem , Gene Flow , Likelihood Functions , Phylogeny , Statistics as Topic
5.
Rev. latinoam. enferm. (Online) ; 27: e3193, 2019. tab
Article in English, Spanish, Portuguese | LILACS, BDENF | ID: biblio-1043088

ABSTRACT

Objective: to analyze nonverbal communication between nurse and parturient during the active phase of labor in two Portuguese-speaking countries. Method: a quantitative and analytical study, whose sample consisted of 709 interactions that used the nonverbal communication of nurses and parturients. The analyzed variables were: distance; posture; axis; contact; emblematic gestures; illustrator gestures and regulatory gestures. For the analysis of the data, the Chi-Square and Likelihood Ratio tests were used. Results: the intimate distance between nurse and parturient in both countries (p = 0.005) prevailed. In both, touch was the most commonly used form of contact (p <0.0001). In both countries, the parturient remained lying down (p <0.0001). In relation to the established contact (p <0.0001), the parturient did not use contact. The face-to-face axis predominated in the interactions in both countries between nurse-parturient (p <0.0001) and parturient-nurse (p <0.0001). Conclusion: similarities were observed in non-verbal communication between nurses and parturients in both countries. However, there are differences such as the established contact between Brazilian and Cape Verdean nurses to parturients.


Objetivo: analisar a comunicação não verbal entre enfermeiro e parturiente durante a fase ativa do trabalho de parto em dois países lusófonos. Método: estudo quantitativo analítico, cuja amostra foi composta por 709 interações que utilizaram a comunicação não verbal dos enfermeiros e parturientes. As variáveis analisadas foram: distância; postura; eixo; contato; gestos emblemáticos; gestos ilustradores e gestos reguladores. Para a análise dos dados, utilizaram-se os testes de Qui-Quadrado e Razão de Verossimilhança. Resultados: a distância íntima entre enfermeiro e parturiente nos dois países (p=0,005) prevaleceu. Em ambos, o toque foi a forma de contato (p<0,0001) mais usada. Nos dois países, as parturientes permaneceram deitadas (p<0,0001). Em relação ao contato estabelecido (p<0,0001), as parturientes não usaram contato. O eixo face a face predominou nas interações em ambos os países entre enfermeiro-parturiente (p<0,0001) e parturiente-enfermeiro (p<0,0001). Conclusão: perceberam-se semelhanças nos aspectos de comunicação não verbal entre enfermeiros e parturientes nos dois países. No entanto, observam-se diferenças como o contato estabelecido entre os enfermeiros brasileiros e cabo-verdianos à parturiente.


Objetivo: analizar comunicación no verbal entre enfermero y parturienta durante la fase activa del trabajo de parto en dos países lusohablantes. Método: estudio analítico cuantitativo, cuya muestra consistió en 709 interacciones que utilizaron la comunicación no verbal entre enfermeros y parturientas. Las variables analizadas fueron: distancia, postura, eje, contacto, gestos emblemáticos, gestos ilustradores y gestos reguladores. Para el análisis de los datos se utilizaron las pruebas de Chi-cuadrado y Razón de Verosimilitud. Resultados: la distancia íntima entre enfermero y parturienta en los dos países (p=0,005) prevaleció. En ambos, el toque fue la forma de contacto (p<0,0001) más usada. En los dos países las parturientas permanecieron acostadas (p<0,0001). En relación al contacto establecido (p<0,0001) las parturientas no usaron contacto. El eje cara a cara predominó en las interacciones en los dos países, entre enfermero-parturienta (p<0,0001) y parturienta-enfermero (p<0,0001). Conclusión: se percibió semejanzas en los aspectos de comunicación no verbal entre enfermeros y parturientas en los dos países. Sin embargo, se observan diferencias como es el caso del contacto establecido entre los enfermeros brasileños y los de Cabo Verde con la parturienta.


Subject(s)
Humans , Female , Pregnancy , Labor, Obstetric/psychology , Women's Health , Natural Childbirth/instrumentation , Nonverbal Communication/psychology , Obstetric Nursing/organization & administration , Brazil , Chi-Square Distribution , Likelihood Functions , Cabo Verde
6.
Ciênc. Saúde Colet ; 23(8): 2713-2720, Aug. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952733

ABSTRACT

Resumo O objetivo deste artigo é identificar os fatores de risco de óbito neonatal em região do interior paulista. Estudo de casos e controles. O grupo casos foi constituído por 162 crianças/óbitos neonatais ocorridos em 2009 na região do Departamento Regional de Saúde VI- Bauru/SP. Compuseram o grupo controle 324 crianças selecionadas do Sistema de Informações de Nascidos Vivos dentre aquelas com o mesmo ano de nascimento e município de residência. Para identificar os fatores associados ao óbito neonatal, realizou-se análise de regressão logística univariada e múltipla hierarquizada, estimando-se as razões de odds (e respectivos intervalos de confiança de 95%) brutas e ajustadas para potenciais fatores de confusão. Apresentaram maior chance de óbito os neonatos cujas mães tinham história de óbito infantil, realizaram até três consultas pré-natais e idade gestacional inferior a 28 semanas. A influência do peso ao nascer foi observada apenas entre crianças com peso inferior a 1500g. Este estudo identificou, de maneira independente, cinco fatores de risco para o óbito neonatal, com destaque para a história materna de óbito infantil anterior, fator ainda não valorizado em estudos prévios.


Abstract The main objective of this study was to identify risk factors for neonatal death in an inland region of the State of São Paulo. A case-control study was conducted using a case group of 162 child deaths that occurred in 2009 in the state's VI Regional Health Department - Bauru. The control group consisted of 324 children selected from the Live Births Information System database who shared the same birth date and city of residence. Univariate and hierarchical multiple logistic regression analyses were performed to identify the factors associated with neonatal death by calculating crude odds ratios adjusted for potential confounders and respective 95% confidence intervals. Results: The likelihood of neonatal death was greater among women who had had a history of infant death (OR = 24.97, CI = 12.20 to 51.10) and who had had only up to three antenatal appointments (OR = 11.40, CI = 5, 92 to 21.93), and among infants born at less than 28 weeks of gestation (OR = 168.00, CI = 49.63 to 568.66). The influence of birth weight was also observed among newborns weighing under 1,500g. Conclusions: This study identified five independent risk factors for neonatal death, the most notable of which is maternal history of neonatal death, which has not been properly acknowledged as a risk factor by previous studies.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Adult , Young Adult , Prenatal Care/statistics & numerical data , Birth Weight , Gestational Age , Perinatal Death , Brazil/epidemiology , Case-Control Studies , Likelihood Functions , Logistic Models , Risk Factors , Databases, Factual , Infant, Extremely Premature
7.
Ciênc. Saúde Colet ; 23(4): 1089-1096, abr. 2018. tab
Article in Spanish | LILACS | ID: biblio-952643

ABSTRACT

Resumen El objetivo del trabajo es evaluar la presencia de ideación suicida y sintomatología depresiva a partir de variables predictoras en adolescentes de Chiapas, México. El estudio es de tipo transversal, ex post-facto. Se aplicaron las escalas de Ideación Suicida, de Depresión del Centro de Estudios Epidemiológicos, Impulsividad y Autoestima, a una muestra no probabilística de 4,759 estudiantes de ambos sexos, con una edad promedio de 18.4 años. Los resultados indican que el puntaje de media para la ideación suicida (0.2), es inferior a lo reportado en otros estudios, mientras que para sintomatología depresiva, es similar. La prevalencia de ideación suicida es del 7.8%, por debajo de los índices señalados en el ámbito nacional e internacional. Los modelos de regresión logística multivariable para ideación suicida, confirman que la impulsividad y sintomatología depresiva, la hacen aumentar a casi el doble (OR= 1.907) y nueve veces (OR= 9.006) respectivamente. Es evidente la estrecha relación entre la ideación suicida y la sintomatología depresiva, señalándose la relevancia que esta tiene como predictora de su presencia en población adolescente.


Abstract The aim of this study was to assess the presence of suicidal ideation and depressive symptoms among adolescents in Chiapas, Mexico based on predictor variables. A cross-sectional study adopting an ex post facto design was conducted with a non-probability sample of 4,759 students of both sexes with an average age of 18.4 years and using the following tools: the Center for Epidemiologic Studies Depression Scale, Roberts' Suicidal Ideation Scale, the Impulsiveness Scale (IS), and the Rosenberg Self-Esteem Scale. The mean score obtained by the suicidal ideation scale was 0.2, which is lower than that reported by other studies, while the mean score for depressive symptoms was similar to those in the literature. The prevalence of suicidal ideation was 7.8%, which is lower than reported in national and international studies. Multivariable logistic regression showed that impulsiveness (OR = 1.907) and depressive symptoms (OR = 9.006) lead to a twofold and ninefold increase in the likelihood of suicidal ideation, respectively. The findings also showed a strong association between suicidal ideation and depressive symptoms, showing that the latter is a predictor of suicidal ideation among adolescents.


Subject(s)
Humans , Male , Female , Adolescent , Aged , Students/statistics & numerical data , Depression/epidemiology , Suicidal Ideation , Impulsive Behavior , Psychiatric Status Rating Scales , Self Concept , Students/psychology , Likelihood Functions , Logistic Models , Prevalence , Cross-Sectional Studies , Mexico/epidemiology
8.
Asian Nursing Research ; : 91-98, 2018.
Article in English | WPRIM | ID: wpr-715466

ABSTRACT

PURPOSE: Authors develop a unified structural model that defines multirelationships between systematic factors causing excessive use of smartphones and the corresponding results. METHODS: A survey was conducted with adolescents who live in Seoul, Pusan, Gangneung, Donghae, and Samcheok from February to March 2016. Authors used SPSS, version 22.0, and AMOS, version 22.0, to analyze the survey results at a .05 significance level. To investigate demographic characteristics of the participants and their variations, descriptive analysis was used. The maximum likelihood estimate method was adopted to verify the fitness of the hypothetical model and the hypotheses therein. Authors used χ² statistics, goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, normed fit index, incremental fit index, root mean square residual, and root mean square error of approximation to verify the fitness of our structural model. RESULTS: (1) The proposed structural model demonstrated a fine fitness level. (2) The proposed structural model could describe the excessive use of a smartphone with 88.6% accuracy. (3) The absence of the family function and relationship between friends, impulsiveness, and low self-esteem were confirmed as key factors that cause an excessive use of smartphones. (4) Furthermore, impulsiveness and low self-esteem are closely related to the absence of family functions and relations between friends by 68.3% and 54.4%, respectively. CONCLUSION: Authors suggest that nursing intervention programs from various angles are required to reduce adolescents' excessive use of smartphones. For example, family communication programs would be helpful for both parents and children. Consultant programs about relationships with friends would also be helpful.


Subject(s)
Adolescent , Child , Consultants , Friends , Humans , Impulsive Behavior , Likelihood Functions , Methods , Models, Structural , Nursing , Parents , Self Concept , Seoul , Smartphone
9.
Clinics ; 73: e261, 2018. tab, graf
Article in English | LILACS | ID: biblio-890756

ABSTRACT

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.


Subject(s)
Humans , Pancreas/pathology , Pancreatic Neoplasms/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation , Needles/standards , Pancreatic Neoplasms/diagnostic imaging , Likelihood Functions , Randomized Controlled Trials as Topic , Sensitivity and Specificity , Efficiency , Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards , Data Accuracy
10.
Rev. bras. med. trab ; 15(2): 167-172, abr.-jun. 2017.
Article in Portuguese | LILACS | ID: biblio-848126

ABSTRACT

Contexto: O conhecimento e a utilização de metodologias de epidemiologia clínica no cenário atual da prática da medicina do trabalho pode ser um diferencial importante para o profissional que atua no setor. Frequentemente, o médico solicita testes ou encontra-se diante de resultados de exames, devendo decidir sobre a validade ou não de um diagnóstico realizado por colegas, muitas vezes, de outras especialidades. O eletroencefalograma (EEG) é um desses exemplos. A Associação Nacional de Medicina do Trabalho/Associação Médica Brasileira (ANAMT/AMB) publicou, em 2016, a diretriz "Epilepsia e Trabalho", visando orientar seus associados. Nessa diretriz não recomenda a utilização do eletroencefalograma no rastreamento da epilepsia. Objetivos: O presente artigo pretende discutir a utilização da razão de verossimilhança (RV) na avaliação clínica de exames médicos, notadamente no EEG, objetivando comparar os resultados obtidos com essa metodologia da medicina baseada em evidências. Métodos: Inicialmente, realizou-se uma busca bibliográfica em relação à RV na literatura clássica da medicina baseada em evidência. Posteriormente, fez-se a leitura da diretriz e das referências bibliográficas nela citadas, retirando os elementos importantes para o cálculo da RV. Após calcular a RV, realizou-se a comparação dos resultados. Resultados: Foram obtidas RV entre 2,36 e 43,5% dependendo da metodologia de realização do EEG (inicial ou sequencial). Conclusões: O EEG não mostrou ser importante no rastreamento da epilepsia, sempre tendo valor menor do que a percentagem de falso-positivos, mesmo nos casos em que se considera a especificidade de 98,0%, corroborando as recomendações da diretriz.


Background: Knowledge of and use of clinical epidemiology methods within the current scenario of occupational medicine practice might make a difference for the professionals who work in this field. Doctors frequently request or receive the results of tests and must decide on the validity or not of diagnoses made by colleagues, often from other specialties. Electroencephalography (EEG) is one example of this situation. In 2016 the National Association of Occupational Medicine/Brazilian Medical Association (ANAMT/ AMB) published the "Epilepsy and Work" guideline to orient its members, which does not recommend EEG for screening. Objectives: The present article discusses the use of likelihood ratio (LR) for clinical evaluation of medical tests, especially EEG, aiming at comparing the results obtained by means of this evidence-based medicine method. Methods: First a literature search on LR was conducted in the classical literature of evidence-based medicine. Next, the ANAMT/AMB guideline and its bibliographic references were analyzed, and relevant elements for the calculation of LR were extracted. LRs were calculated and the results were compared. Results: The LR values varied from 2.36 to 43.5% according to the EEG method used (initial or sequential). Conclusions: EEG proved not to be relevant for screening for epilepsy, with values systematically lower than the percentage of false-positive results, even in cases when 98.0% of specificity was considered, thus corroborating the recommendation made in ANAMT/AMB guideline.


Subject(s)
Mass Screening , Medical Care Statistics , Practice Guidelines as Topic , Electroencephalography/instrumentation , Epilepsy/diagnosis , Epilepsy/epidemiology , Occupational Medicine/standards , Likelihood Functions , Evidence-Based Medicine
11.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 903-908
in English | IMEMR | ID: emr-188610

ABSTRACT

Objectives: This study was conducted to adduce evidence of validity for admissions tests and processes and for identifying a parsimonious model that predicts students' academic achievement in Medical College


Methods: Psychometric study done on admission data and assessment scores for five years of medical studies at Aga Khan University Medical College, Pakistan using confirmatory factor analysis [CFA] and structured equation modeling [SEM]. Sample included 276 medical students admitted in 2003, 2004 and 2005


Results: The SEM supported the existence of covariance between verbal reasoning, science and clinical knowledge for predicting achievement in medical school employing Maximum Likelihood [ML] estimations [n=112]. Fit indices: X[2] [21] = 59.70, p =<.0001; CFK873; RMSEA= 0.129; SRMR = 0.093


Conclusions: This study shows that in addition to biology and chemistry which have been traditionally used as major criteria for admission to medical colleges in Pakistan; mathematics has proven to be a better predictor for higher achievements in medical college


Subject(s)
Humans , Female , Male , Adolescent , Young Adult , Psychometrics , Factor Analysis, Statistical , Chemistry , Biology , Likelihood Functions
12.
Audiol., Commun. res ; 22: e1856, 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-950630

ABSTRACT

RESUMO Introdução A fonoaudiologia tem assumido importante papel junto ao aleitamento materno. Objetivo Verificar a situação do aleitamento materno, considerando aspectos da díade mãe-recém-nascido, de acordo com tempo de vida do recém-nascido, mediante intervenção fonoaudiológica. Métodos Estudo realizado de maio de 2015 a setembro de 2016, com 166 díades mãe-recém-nascido, durante a situação do aleitamento materno, em uma maternidade pública de alto risco do estado de Sergipe. Foi utilizado protocolo específico, registrando-se aspectos anatômicos de bicos e mamas maternos, estado comportamental, padrão de pega e sucção dos recém-nascidos e postura das díades, para descrever a situação de aleitamento materno, nos três diferentes momentos: Momento 1 (linha de base); Momento 2 (intervenção fonoaudiológica); Momento 3 (acompanhamento). As análises foram descritas por meio de frequências simples e percentuais, utilizando o teste de Mantel-Haenzsel (M-H) e o teste da razão de verossimilhança (TRV), adotando nível de significância de 5%. Resultados Em relação ao efeito da intervenção fonoaudiológica, houve diferença significativa quanto aos parâmetros maternos, para situação das mamas (ingurgitamento). Nos parâmetros envolvendo os recém-nascidos, houve diferenças significativas, com melhora no padrão de pega, quanto aos seguintes aspectos: não abocanha somente o bico, abocanha parte da aréola, pega efetiva e consegue manter a pega. Quanto aos aspectos posturais da díade, houve diferenças significativas quanto à cabeça do recém-nascido elevada e alinhada e ao contato corporal ("barriga com barriga"). Conclusão A intervenção fonoaudiológica junto às díades mães-recém-nascidos, logo nas primeiras horas pós-parto, evidenciou melhora nos parâmetros considerados fundamentais para o sucesso da amamentação, vislumbrando uma prática de educação em saúde junto às puérperas.


ABSTRACT Introduction Speech therapy has assumed an important role with breastfeeding. Purpose To verify the breastfeeding situation, considering aspects of the mother-newborn dyad, according to newborn's lifetime through speech-language intervention. Methods Study conducted from May 2015 to September 2016, with 166 mother-newborn dyads during the breastfeeding situation, in a high-risk public maternity hospital in the state of Sergipe. A specific protocol was used registering anatomical aspects of nipples and breasts, newborn's behavioral status, newborn suckling and breast-latch pattern and dyads posture to describe the breastfeeding situation at different times: Moment 1 (Baseline); Moment 2 (Speech-Language Intervention); Moment 3 (Accompaniment). The results were described using simple and percentage frequencies, Mantel-Haenzsel Test (M-H) and the Likelihood Ratio Test (LRT), adopting significance level of 5%. Results Regarding the effect of the speech-language intervention, there was a significant difference in the maternal parameters for the breasts situation (regorgement); While in the parameters involving the newborns there were significant differences, with improvement in breast-latch patterns aspects such as: do not only pick up the beak, snatch part of the areola, breast-latcheffectively and manage to keep breast-latchpattern. Regarding the dyad postural aspects, there were significant differences regarding newborn's raised andaligned head and body contact (belly-to-belly). Conclusion Speech-language intervention with the mother-newborn dyads in the first hours after delivery showed an improvement in the parameters considered fundamental on a successful breastfeeding glimpsing a health education practice among the puerperal women.


Subject(s)
Humans , Infant, Newborn , Sucking Behavior , Breast Feeding , Health Education , Postpartum Period , Brazil , Breast/anatomy & histology , Likelihood Functions , Longitudinal Studies , Speech, Language and Hearing Sciences , Maternal Health , Health Promotion , Mother-Child Relations
13.
Article in English | WPRIM | ID: wpr-217747

ABSTRACT

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.


Subject(s)
Education , Herniorrhaphy , Humans , Learning Curve , Learning , Likelihood Functions , Retrospective Studies
14.
Article in English | WPRIM | ID: wpr-277923

ABSTRACT

Objective To establish a Daphnia model of alloxan-induced diabetes. Methods Daphnia were exposed to three different concentrations of alloxan (3, 5, and 10 mmol/L) for 30 minutes. Blood glucose and survival rate were recorded for 72 hours after alloxan insult. Sequence analysis and phylogenetic inference for glucose transporters (GLUT) were clustered with the maximum-likelihood method. Using reverse transcription and quantitative polymerase chain reaction techniques, we investigated the transcriptional changes of GLUT at 12 hours after alloxan (5 mmol/L) exposure. Results Compared with control, 3 mmol/L, and 5 mmol/L as well as 10 mmol/L alloxan initially induced transient blood glucose decline by 15% for 2 hours and 12 hours respectively. In Daphnia with 5 and 10 mmol/L alloxan, their blood glucose was persistently raised by about 150% since after 24-hour insult. Survival rate of Daphnia exposure to alloxan with concentrations of 3, 5, and 10 mmol/L were 90%, 75%, and 25% respectively. We predicted seven GLUT genes in the Daphnia genome and successfully amplified them using real-time polymerase chain reaction. Two of seven GLUT transcripts were down-regulated in Daphnia with 5 mmol/L alloxan-induced diabetes. Conclusion Alloxan-induced diabetes model was successfully established in the Daphnia pulex, suggesting diabetes-relevant experiments can be conducted using Daphnia.


Subject(s)
Alloxan , Animals , Blood Glucose , Daphnia , Diabetes Mellitus, Experimental , Disease Models, Animal , Gene Expression Regulation , Glucose Transport Proteins, Facilitative , Genetics , Metabolism , Likelihood Functions , Phylogeny , Real-Time Polymerase Chain Reaction
15.
Chinese Medical Journal ; (24): 578-585, 2016.
Article in English | WPRIM | ID: wpr-328197

ABSTRACT

<p><b>BACKGROUND</b>Several studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have indicated that cognitive remediation therapy (CRT) might improve cognitive function by changing brain activations in patients with schizophrenia. However, the results were not consistent in these changed brain areas in different studies. The present activation likelihood estimation (ALE) meta-analysis was conducted to investigate whether cognitive function change was accompanied by the brain activation changes, and where the main areas most related to these changes were in schizophrenia patients after CRT. Analyses of whole-brain studies and whole-brain + region of interest (ROI) studies were compared to explore the effect of the different methodologies on the results.</p><p><b>METHODS</b>A computerized systematic search was conducted to collect fMRI and PET studies on brain activation changes in schizophrenia patients from pre- to post-CRT. Nine studies using fMRI techniques were included in the meta-analysis. Ginger ALE 2.3.1 was used to perform meta-analysis across these imaging studies.</p><p><b>RESULTS</b>The main areas with increased brain activation were in frontal and parietal lobe, including left medial frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right postcentral gyrus, and inferior parietal lobule in patients after CRT, yet no decreased brain activation was found. Although similar increased activation brain areas were identified in ALE with or without ROI studies, analysis including ROI studies had a higher ALE value.</p><p><b>CONCLUSIONS</b>The current findings suggest that CRT might improve the cognition of schizophrenia patients by increasing activations of the frontal and parietal lobe. In addition, it might provide more evidence to confirm results by including ROI studies in ALE meta-analysis.</p>


Subject(s)
Brain , Cognition , Cognitive Remediation , Humans , Likelihood Functions , Magnetic Resonance Imaging , Positron-Emission Tomography , Schizophrenia , Diagnostic Imaging , Therapeutics
16.
Gastroenterology and Hepatology from Bed to Bench. 2016; 9 (1): 18-24
in English | IMEMR | ID: emr-174978

ABSTRACT

Aim: The aim of this study was to evaluate the likelihood ratio and frequency of DQ2 and DQ8 in Iranian patients with celiac disease [CD]


Background: The HLA DQ2 and HLA DQ8 are the important mediators in the development of celiac disease. A few studies evaluated the frequency of HLA DQ2 and HLA DQ8 haplotypes among the Iranian population with low sample size


Patients and methods: In this cross-sectional study, to predict HLA-DQ2 and DQ8 haplotypes, 141[73 male, 78 female] confirmed CD patients compared to 151 healthy controls were enrolled into this study during 2013-2014. HLA DQ2/ DQ8 haplotypes was determined in cases and controls using PCR-SSP technique


Results: DQ2 and DQ8 were positive in 80% [n=111] and 49% [n= 69] of CD patients and 36% [n=61] and 13% [n=21] of control group respectively. Moreover, 32% [n=45] of CD patients and 5.3% [n=8] of the control group were carrier of both haplotypes. In the case group about one-third of patients [32.2%] were positive for carrying both DQ2 and DQ8 heterodimers while only 5.3% [n=8] of the control group were carrier. In addition, the positive likelihood ratio of DQ2 and DQ8 were 1.74 [CI: 1.4- 2.1], and 2.6 [CI: 1.8- 2.7], respectively


Conclusion: The result of this study showed that the frequency of DQ8 among our population is higher than those reported by European countries, but it is close to those founded in South America and Middle East. This result suggests that the higher prevalence of HLA DQ8 pattern in Iranian CD patients is similar to non-European patients


Subject(s)
Adult , Humans , Female , Male , Likelihood Functions , HLA-DQ Antigens , Haplotypes , Cross-Sectional Studies , Patients
17.
São Paulo; s.n; s.n; 2016. 317 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-846664

ABSTRACT

A natureza e diversidade das estruturas químicas com atividade farmacológica que se tem encontrado nos organismos marinhos justificam a busca por novos compostos que são de interesse nas mais diversas áreas de aplicação. As espécies de macroalgas vermelhas, em especial Laurencia spp., merecem destaque pela enorme variedade de terpenos e acetogeninas que produzem, sendo consideradas de grande potencial na produção de novos fármacos. O estudo de seus constituintes pode fornecer importantes subsídios para a quimiotaxonomia, ecologia química, caracterização das espécies e avaliação do potencial biotecnológico. Baseado nisso, Laurencia aldingensis, L. dendroidea e Laurenciella sp. foram selecionadas para o presente estudo para isolamento, caracterização e teste de atividades biológicas dos seus compostos. A técnica do DNA barcoding foi utilizada como ferramenta de diagnóstico para garantir a similaridade entre as amostras de cada espécie, que foram coletadas em época e locais diferentes. Do extrato orgânico de Laurencia aldingensis, nove substâncias foram isoladas, sendo quatro esfingosinas (1-4), três terpenos (5-7) e duas novas substâncias halogenadas (8 e 9). Do extrato orgânico de Laurencia dendroidea formam isolados dois terpenos halogenados conhecidos (10, 11) e, do extrato de Laurenciella sp. três novas substâncias halogenadas alifáticas insaturadas (12-14), assim como um ácido graxo (15) e um esterol (16) conhecidos. Dentre elas, a 8 apresentou atividade citotóxica, mas não se mostrou seletivo, e as substâncias 4 e 11 apresentaram atividade esquistossomicida, bastante promissora. No entanto, nenhum deles apresentou atividade antioxidante. Diante desta investigação, podemos dizer que as informações geradas com os estudos de Laurencia aldingensis, L. dendroidea e Laurenciella sp. expandiram significantemente o conhecimento no que tange a diversidade química no gênero e o potencial biológico-farmacêutico dos mesmos


The nature and diversity of chemical structures with pharmacological activity that have been found in marine organisms justifies the search for new compounds that may have applications in various areas of interest. Species of red seaweeds, especially Laurencia spp., are special because of the unprecedented variety of terpenes and acetogenins they produce that are considered potentially useful for the production of new drugs. Study of their constituents can also provide important insights relating to their chemotaxonomy, chemical ecology, characterization of species and biotechnological potential. On this basis Laurencia aldingensis, L. dendroidea and Laurenciella sp., were selected for study and isolation, characterization, and biological activity assessment of isolatable quantities of their compounds. The technique of DNA barcoding was used as a diagnostic tool to ensure similarity between samples of each species collected at different times and places. From the organic extract of Laurencia aldingensis nine compounds were isolated; four sphingosines (1-4), three terpenes (5-7) and other two new halogenated compound (8, 9). From the organic extract of Laurencia dendroidea two known halogenated terpenes (10, 11) were isolated while from a similar extract of Laurenciella sp., three new halogenated aliphatic compounds (12-14) were isolated together with known fatty acid (15) and sterol (16). Among all isolates, 8 demonstrated unspecific cytotoxic activity and compounds 4 and 11 showed promising schistosomicidal activity. In applied antioxidant assays none of the isolates we noted to have activity. From the overall investigation it is also clear that the information gleaned from the studies of Laurencia aldingensis, L. dendroidea and Laurenciella sp., significantly expanded our knowledge base concerning chemical diversity in the genus Laurencia and their biological-pharmaceutical potential


Subject(s)
Bioprospecting/methods , DNA Barcoding, Taxonomic/statistics & numerical data , Seaweed/metabolism , Antioxidants , Biological Phenomena/analysis , Biological Products/administration & dosage , Cytotoxins , Likelihood Functions , Rhodophyta/metabolism , Sphingosine , Terpenes
18.
Salud pública Méx ; 57(6): 496-503, nov.-dic. 2015. tab
Article in English | LILACS | ID: lil-770750

ABSTRACT

Objective. To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. Materials and methods. Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. Results. The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). Conclusion. It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.


Objetivo. Determinar las tasas de sintomáticos respiratorios y de incidencia de tuberculosis pulmonar en dos zonas fronterizas de Ecuador, y contrastarlas con cifras oficiales. Material y métodos. Encuesta transversal aplicada en comunidades fronterizas Sur Oriental (FSO) y Sur Andina (FSA) a 1 598 y 2 419 mayores de 15 años, respectivamente. A los sintomáticos respiratorios se les realizó una baciloscopía en esputo. Las tasas y razón de momios se compararon frente a cifras oficiales mediante contraste de verosimilitudes. Resultados. Las tasas de sintomáticos respiratorios (7.7 y 5.9% en FSO y FSA, respectivamente) y de tuberculosis pulmonar (incidencia acumulada 125 y 140 por 100 000 habitantes, respectivamente) discrepan de las cifras oficiales (0.98 y 0.99% de sintomáticos respiratorios, respectivamente; y, 38.23 por 10(5) habitantes para tuberculosis pulmonar en Ecuador) (p<0.001). Conclusión. Fortalecer la búsqueda de sintomáticos respiratorios y la vigilancia epidemiológica de la tuberculosis pulmonar en áreas fronterizas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tuberculosis, Pulmonary/epidemiology , Population Surveillance/methods , Crowding , Likelihood Functions , Cross-Sectional Studies , Health Surveys , Ecuador/epidemiology , Social Marginalization , Social Determinants of Health , Literacy , Housing , Mycobacterium tuberculosis/isolation & purification
19.
Einstein (Säo Paulo) ; 13(4): 525-529, Oct.-Dec. 2015. tab
Article in Portuguese | LILACS | ID: lil-770493

ABSTRACT

ABSTRACT Objective To identify the association between perinatal/neonatal factors and symptoms of eating disorders among college students. Methods Four hundred and eight college students (283 women), aged 18 to 23 years old, enrolled in the first semester of a Bachelor of Health Science degree program were included in the sample. Eating disorder symptoms and body image dissatisfaction were assessed with the Eating Attitudes Test and Bulimic Investigatory Test of Edinburgh. Information regarding birth weight, breastfeeding, obstetric complications, mother’s age at delivery, type of delivery, and birth order were self-reported by the volunteers after consulting their parents. Association between perinatal and neonatal factors and symptoms of anorexia nervosa and bulimia nervosa were assessed by binary logistic regression adjusted for sex, age, and body mass index. Results The likelihood of presenting with symptoms of anorexia nervosa was 0.5 time lower for those students born from the oldest mothers (odds ratio – OR=0.37; 95% confidence interval – 95%CI: 0.17-0.83). Relative to bulimia nervosa, the risk was higher among students who reported obstetric complications (OR=2.62; 95%CI: 1.03-6.67). Conclusion We observed the association between perinatal and neonatal factors with symptoms of eating disorders in college students.


RESUMO Objetivo Identificar a associação entre fatores perinatais/neonatais e sintomas de transtornos alimentares entre estudantes universitários. Métodos Quatrocentos e oito estudantes universitários (283 mulheres), com idade entre 18 e 23 anos, matriculados no primeiro semestre de cursos de Bacharelado na área das Ciências da Saúde foram incluídos na amostra. Sintomas de transtornos alimentares e de insatisfação com a imagem corporal foram avaliados por meio do Eating Attitudes Test e do Bulimic Investigatoty Test of Edinburgh. Informações sobre o peso ao nascer, aleitamento materno, complicações obstétricas, idade materna no momento do parto, tipo de parto e ordem de nascimento foram relatadas pelos voluntários após consulta com seus pais. A associação entre fatores perinatais/neonatais e sintomas de anorexia nervosa e bulimia nervosa foi avaliada por meio de regressão logística binária ajustada por sexo, idade e índice de massa corporal. Resultados A probabilidade de apresentar sintomas de anorexia nervosa foi 0,5 vez mais baixa para os alunos nascidos de mães mais velhas (odds ratio – OR=0,37; intervalo de confiança de 95% – IC 95%=0,17-0,83). Em relação à bulimia nervosa, o risco foi maior entre os estudantes que relataram complicações obstétricas (OR=2,62; IC 95%=1,03-6,67). Conclusão Observou-se associação entre fatores perinatais e neonatais com sintomas de transtornos alimentares em estudantes universitários.


Subject(s)
Adolescent , Female , Humans , Male , Pregnancy , Young Adult , Feeding and Eating Disorders/etiology , Maternal Age , Pregnancy Complications/psychology , Students, Health Occupations/statistics & numerical data , Anorexia Nervosa/etiology , Behavior Rating Scale , Birth Weight , Body Mass Index , Breast Feeding , Body Image/psychology , Bulimia Nervosa/etiology , Delivery, Obstetric/statistics & numerical data , Feeding Behavior , Likelihood Functions , Logistic Models , Risk Factors
20.
Rev. bras. cir. cardiovasc ; 30(6): 605-609, Nov.-Dec. 2015. tab
Article in English | LILACS | ID: lil-774542

ABSTRACT

ABSTRACT OBJECTIVE: To test several weaning predictors as determinants of successful extubation after elective cardiac surgery. METHODS: The study was conducted at a tertiary hospital with 100 adult patients undergoing elective cardiac surgery from September to December 2014. We recorded demographic, clinical and surgical data, plus the following predictive indexes: static compliance (Cstat), tidal volume (Vt), respiratory rate (f), f/ Vt ratio, arterial partial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2), and the integrative weaning index (IWI). Extubation was considered successful when there was no need for reintubation within 48 hours. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were used to evaluate each index. RESULTS: The majority of the patients were male (60%), with mean age of 55.4±14.9 years and low risk of death (62%), according to InsCor. All of the patients were successfully extubated. Tobin Index presented the highest SE (0.99) and LR+ (0.99), followed by IWI (SE=0.98; LR+ =0.98). Other scores, such as SP, NPV and LR-were nullified due to lack of extubation failure. CONCLUSION: All of the weaning predictors tested in this sample of patients submitted to elective cardiac surgery showed high sensitivity, highlighting f/Vt and IWI.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Heart Valves/surgery , Respiration, Artificial/methods , Ventilator Weaning/statistics & numerical data , Airway Extubation , Elective Surgical Procedures/statistics & numerical data , Likelihood Functions , Postoperative Period , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Tidal Volume/physiology , Ventilator Weaning/methods
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