ABSTRACT
OBJECTIVE: To analyze the temporal trend of Food and Nutrition Surveillance System (SISVAN) coverage and nutritional status of adults undergoing follow-up in the Brazilian Primary Health Care, 2008-2019. METHODS: This was an ecological time series study using data on Brazilian macro-regions. The annual percent change in the classification of nutritional status and total coverage was estimated using the Prais-Winsten regression model. RESULTS: A total of 115,034,534 records were identified in the period. Coverage increased from 5.0% in 2008 to 10.6% in 2019, with an annual change of 8.4%, 95% confidence interval (95%CI 6.7;10.0). Obesity and overweight showed a rising trend between 2008 and 2019, with an annual change of 6.4% (95%CI 5.3;7.3) and (1.8%; 95%CI 1.2;2.5) respectively, while underweight (-7.0%; 95%CI -8.0;-6.1) and eutrophy (-3.8%; 95%CI -4.1;-3.4) decreased in the period. CONCLUSION: There was an improvement in SISVAN coverage, with an increase in overweight and obesity among the population studied.
Subject(s)
Nutritional Status , Overweight , Adult , Brazil/epidemiology , Food , Humans , Obesity/epidemiology , Overweight/epidemiologyABSTRACT
Objective: To analyze temporal trend of Food and Nutrition Surveillance System (SISVAN) coverage and nutritional status of adults followed up in Primary Health Care in Brazil, 2008-2019. Methods: Ecological time series study with data from Brazilian macro-regions. Annual percent change in nutritional status classification and total coverage were estimated by Prais-Winsten regression. Results: 115,034,534 records were identified in the period. The coverage was from 5.0% in 2008 to 10.6% in 2019, with an annual change of 8.4% (95% confidence interval [95%CI] 6.7;10.0). Obesity showed an increasing trend between 2008 and 2019, with an annual change of 6.4% (95%CI 5.3;7.3), as did overweight (1.8% 95%CI 1.2;2.5). Underweight (-7.0% 95%CI -8.0;-6.1) and eutrophy (-3.8% 95%CI -4.1;-3.4) decreased in the period. Conclusion: An improvement in SISVAN coverage was identified, but accompanied by an increase in overweight and obesity.
Objetivo: Analizar la tendencia temporal de la cobertura del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) y del estado nutricional de los adultos acompañados en la Atención Primaria de Brasil, 2008-2019. Métodos: Estudio de series temporales ecológico con datos de macrorregiones brasileñas. La variación porcentual anual del estado nutricional y la cobertura total se estimaron mediante regresión de Prais-Winsten. Resultados: Fueran 115.034.534 registros en el periodo. La cobertura pasó del 5,0% en 2008 al 10,6% en 2019, con una variación anual del 8,4% (intervalo de confianza del 95% [IC95%]: 6,7;10,0). La obesidad mostró tendencia creciente entre 2008 y 2019, con variación anual del 6,4% (IC95% 5,3;7,3), al igual que el sobrepeso (1,8% IC95% 1,2;2,5). El bajo peso (-7,0% IC95% -8,0;-6,1) y la eutrofia (-3,8% IC95% -4,1;-3,4) disminuyeron en el periodo. Conclusión: Se identificó mejora en la cobertura del SISVAN, pero acompañada de un aumento del sobrepeso y la obesidad.
Objetivo: Analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN) e do estado nutricional, entre adultos acompanhados na Atenção Primária à Saúde do Brasil, 2008-2019. Métodos: Estudo ecológico de séries temporais, sobre dados das macrorregiões brasileiras. A variação percentual anual da classificação do estado nutricional e da cobertura total foi estimada pela regressão de Prais-Winsten. Resultados: Foram identificados 115.034.534 registros no período. A cobertura passou de 5,0% em 2008 para 10,6% em 2019, com variação anual de 8,4% (intervalo de confiança de 95% [IC95%] 6,7;10,0). A obesidade apresentou tendência crescente entre 2008 e 2019, com variação anual de 6,4% (IC95% 5,3;7,3), assim como o sobrepeso (1,8% IC95% 1,2;2,5). Já o baixo peso (-7,0% IC95% -8,0;-6,1) e a eutrofia (-3,8% IC95% -4,1;-3,4) decresceram no período. Conclusão: Identificou-se melhora na cobertura do SISVAN, tendo-se observado aumento de excesso de peso e obesidade na população estudada.
ABSTRACT
Objetivo: Analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e do estado nutricional, entre adultos acompanhados na Atenção Primária à Saúde do Brasil, 2008-2019. Métodos: Estudo ecológico de séries temporais, sobre dados das macrorregiões brasileiras. A variação percentual anual da classificação do estado nutricional e da cobertura total foi estimada pela regressão de Prais-Winsten. Resultados: Foram identificados 115.034.534 registros no período. A cobertura passou de 5,0% em 2008 para 10,6% em 2019, com variação anual de 8,4%, intervalo de confiança de 95% (IC95% 6,7;10,0) A obesidade apresentou tendência crescente entre 2008 e 2019, com variação anual de 6,4% (IC95% 5,3;7,3), assim como o sobrepeso (1,8%; IC95% 1,2;2,5). Já o baixo peso (-7,0%; IC95% -8,0;-6,1) e a eutrofia (-3,8%; IC95% -4,1;-3,4) decresceram no período. Conclusão: Identificou-se melhora na cobertura do Sisvan, tendo-se observado aumento de excesso de peso e obesidade na população estudada.
Objetivo: Analizar la tendencia temporal de la cobertura del Sistema de Vigilancia Alimentaria y Nutricional (Sisvan) y del estado nutricional de los adultos acompañados en la Atención Primaria de Brasil, 2008-2019. Métodos: Estudio ecológico de series emporales con datos de las macrorregiones brasileñas. La variación porcentual anual del estado nutricional y la cobertura total se estimaron mediante regresión de Prais-Winsten. Resultados: Fueran 115.034.534 registros en el periodo. La cobertura pasó del 5,0% en 2008 al 10,6% en 2019, con una variación anual del 8,4%, intervalo de confianza del 95% (IC95% 6,7;10,0). La obesidad mostró tendencia creciente entre 2008 y 2019, con variación anual del 6,4% (IC95% 5,3;7,3), al igual que el sobrepeso (1,8%; IC95% 1,2;2,5). El bajo peso (-7,0%; IC95% -8,0; -6,1) y la eutrofia (-3,8%; IC95% -4,1; -3,4) disminuyeron en el periodo. Conclusión: Se identificó mejora en la cobertura del Sisvan, pero acompañada de un aumento del sobrepeso y de obesidad.
Objective: To analyze the temporal trend of Food and Nutrition Surveillance System (SISVAN) coverage and nutritional status of adults undergoing follow-up in the Brazilian Primary Health Care, 2008-2019. Methods: This was an ecological time series study using data on Brazilian macro-regions. The annual percent change in the classification of nutritional status and total coverage was estimated using the Prais-Winsten regression model. Results: A total of 115,034,534 records were identified in the period. Coverage increased from 5.0% in 2008 to 10.6% in 2019, with an annual change of 8.4%, 95% confidence interval (95%CI 6.7;10.0). Obesity and overweight showed a rising trend between 2008 and 2019, with an annual change of 6.4% (95%CI 5.3;7.3) and (1.8%; 95%CI 1.2;2.5) respectively, while underweight (-7.0%; 95%CI -8.0;-6.1) and eutrophy (-3.8%; 95%CI -4.1;-3.4) decreased in the period. Conclusion: There was an improvement in SISVAN coverage, with an increase in overweight and obesity among the population studied.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Food and Nutritional Surveillance , Nutritional Status , Obesity/epidemiology , Brazil/epidemiology , Time Series Studies , Overweight/epidemiology , Health Information SystemsABSTRACT
We sought to evaluate contact rate reduction goals for household and close contacts and to provide preventive recommendations during the coronavirus pandemic. We applied an agent-based model to simulate the transmission dynamics of SARS-CoV-2 within household or close contacts through a social network of 150 nodes. there is no great difference in total infected people within modifications in number of links per node for networks with average number of links per node greater than three. For six nodes, total infected people are 149.85; for five nodes, 148.97; and for four nodes, 141.57. On the other hand, for three nodes, total infected are 82.39, for two nodes, 13.95; and for one node, 2.96. This model indicates a possible pitfall if social distancing measures are not stepwise suspended and close surveillance of cases are not provided, since the relationship between average links per node and number of infected people seems to be s-shaped, and not linear.
Subject(s)
Betacoronavirus , Communicable Disease Control , Coronavirus Infections/transmission , Family Characteristics , Pneumonia, Viral/transmission , Brazil/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Biological , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Social IsolationABSTRACT
OBJECTIVE: to describe profiles of interest of web search queries related to the Covid-19 epidemic in Brazil. METHODS: this was a quantitative and exploratory study using Google Health Trends. We analyzed daily data of interest, defined as search probability (Pr), in 23 terms in searches performed by users connected in Brazil from January 1 to April 9, 2020. RESULTS: the peak in interest (Pr=0.0651) on the theme of coronavirus occurred on March 21. Interest in use of face masks (Pr=0.0041), social distancing (Pr=0.0043) and hand hygiene with alcohol gel (Pr=0.0037) was greater than interest in respiratory etiquette (Pr=0.0010) and hand hygiene with soap and water (Pr=0.0005). CONCLUSION: the difference in interest in issues related to combating Covid-19 was substantial and can guide new strategies for disseminating health information.
Subject(s)
Coronavirus Infections/epidemiology , Information Seeking Behavior , Internet/statistics & numerical data , Pneumonia, Viral/epidemiology , Brazil/epidemiology , COVID-19 , Humans , Pandemics , Search EngineABSTRACT
Resumo O artigo analisa o mercado de trabalho de auxiliares e técnicos de enfermagem no Ceará, nos anos de 2013 a 2017, nos aspectos relacionados à precarização do trabalho. Duas fontes de dados foram empregadas. A Pesquisa sobre o Perfil da Equipe de Enfermagem no Brasil (PPEB), de caráter transversal, foi utilizada como linha de base, e a Relação Anual de Informações Sociais-RAIS, longitudinal, possibilitou o estudo da evolução de algumas das variáveis relacionadas à precarização do trabalho. Dada a pequena quantidade de estudos semelhantes para essa categoria profissional, optou-se por realizar uma abordagem exploratória que subsidiou uma discussão crítica dos resultados. A precarização do trabalho de auxiliares e técnicos de enfermagem é sustentada por evidências empíricas nas quatro perspectivas adotadas pela Organização Internacional do Trabalho-OIT: temporal, econômica, social e organizacional. Embora seja um mercado com saldo positivo de admissões em relação aos desligamentos, os empregos apresentam baixos salários, vínculos precários, alta rotatividade, ausência de perspectiva de ascensão e condições adversas de trabalho, como exposição a violência, discriminação e acidentes. Conclui-se que os dados da RAIS corroboram os achados da PPEB e apontam que inexiste qualquer tendência de melhora dessa situação.
Abstract The article analyzes the labor market of nursing assistants and technicians in the State of Ceará, Brazil, from 2013 to 2017, concerning job insecurity aspects. Two data sources were employed. The cross-sectional Brazilian Nursing Team Profile Survey (PPEB) was used as the baseline, and the longitudinal Annual List of Social Information (RAIS) database, allowed the study of the trend of some of the variables related to job insecurity. Given the small number of similar studies for this professional category, we opted for an exploratory data approach that supported a critical discussion of the results. The job insecurity of nursing assistants and technicians is supported by empirical evidence in the four perspectives adopted by the International Labor Organization-ILO: time-related, economic, social, and organizational. While it is a market with a positive balance of admissions compared to layoffs, jobs have low salaries, poor work relationships, high turnover, lack of prospect of career advancement, and adverse working conditions such as exposure to violence, discrimination, and accidents. We can conclude that RAIS data corroborate the PPEB findings, and point out that there is no trend of improvement for this situation.
Subject(s)
Employment/statistics & numerical data , Nursing Assistants , BrazilABSTRACT
The article analyzes the labor market of nursing assistants and technicians in the State of Ceará, Brazil, from 2013 to 2017, concerning job insecurity aspects. Two data sources were employed. The cross-sectional Brazilian Nursing Team Profile Survey (PPEB) was used as the baseline, and the longitudinal Annual List of Social Information (RAIS) database, allowed the study of the trend of some of the variables related to job insecurity. Given the small number of similar studies for this professional category, we opted for an exploratory data approach that supported a critical discussion of the results. The job insecurity of nursing assistants and technicians is supported by empirical evidence in the four perspectives adopted by the International Labor Organization-ILO: time-related, economic, social, and organizational. While it is a market with a positive balance of admissions compared to layoffs, jobs have low salaries, poor work relationships, high turnover, lack of prospect of career advancement, and adverse working conditions such as exposure to violence, discrimination, and accidents. We can conclude that RAIS data corroborate the PPEB findings, and point out that there is no trend of improvement for this situation.
O artigo analisa o mercado de trabalho de auxiliares e técnicos de enfermagem no Ceará, nos anos de 2013 a 2017, nos aspectos relacionados à precarização do trabalho. Duas fontes de dados foram empregadas. A Pesquisa sobre o Perfil da Equipe de Enfermagem no Brasil (PPEB), de caráter transversal, foi utilizada como linha de base, e a Relação Anual de Informações Sociais-RAIS, longitudinal, possibilitou o estudo da evolução de algumas das variáveis relacionadas à precarização do trabalho. Dada a pequena quantidade de estudos semelhantes para essa categoria profissional, optou-se por realizar uma abordagem exploratória que subsidiou uma discussão crítica dos resultados. A precarização do trabalho de auxiliares e técnicos de enfermagem é sustentada por evidências empíricas nas quatro perspectivas adotadas pela Organização Internacional do Trabalho-OIT: temporal, econômica, social e organizacional. Embora seja um mercado com saldo positivo de admissões em relação aos desligamentos, os empregos apresentam baixos salários, vínculos precários, alta rotatividade, ausência de perspectiva de ascensão e condições adversas de trabalho, como exposição a violência, discriminação e acidentes. Conclui-se que os dados da RAIS corroboram os achados da PPEB e apontam que inexiste qualquer tendência de melhora dessa situação.
Subject(s)
Employment/statistics & numerical data , Nursing Assistants , BrazilABSTRACT
We sought to evaluate contact rate reduction goals for household and close contacts and to provide preventive recommendations during the coronavirus pandemic. We applied an agent-based model to simulate the transmission dynamics of SARS-CoV-2 within household or close contacts through a social network of 150 nodes. there is no great difference in total infected people within modifications in number of links per node for networks with average number of links per node greater than three. For six nodes, total infected people are 149.85; for five nodes, 148.97; and for four nodes, 141.57. On the other hand, for three nodes, total infected are 82.39, for two nodes, 13.95; and for one node, 2.96. This model indicates a possible pitfall if social distancing measures are not stepwise suspended and close surveillance of cases are not provided, since the relationship between average links per node and number of infected people seems to be s-shaped, and not linear.
O estudo teve como objetivos, avaliar as metas de redução da taxa de contatos domiciliares e próximos, além de fornecer recomendações preventivas durante a pandemia do novo coronavírus. Foi aplicado um modelo baseado em agentes para simular a dinâmica da transmissão do SARS-CoV-2 dentro dos domicílios ou entre contatos próximos, através de uma rede social com 150 nós. Não houve uma diferença grande no número total de pessoas infectadas de acordo com as modificações no número de elos por nó em redes com mais de três elos por nó em média.. Para seis nós, o total de infectados é 149,85; para cinco nós, 148,97 e para quatro nós, 141,57. Por outro lado, para três nós, o total de infectados é 82,39, para dois nós, 13,95 e para um nó, 2,96. O modelo indica uma possível armadilha, caso as medidas de distanciamento social não sejam suspendidas de maneira escalonada, com vigilância rigorosa de casos, uma vez que a relação entre a média de elos por nó e o número pessoas infectadas parece apresentar uma forma em "s", e não linear.
El objetivo fue evaluar las metas alcanzadas en la reducción de las tasas de contacto en los hogares, así como de contactos cercanos, para proporcionar recomendaciones preventivas durante la pandemia de coronavirus. Aplicamos un modelo basado en agentes, con el fin de simular la transmisión dinámica del SARS-CoV-2 dentro del hogar o con contactos cercanos, a través de una red social de 150 nodos. No existe una gran diferencia en el total de personas infectadas en las modificaciones, respecto al número de enlaces por nodo, en el caso de las redes con un promedio de links por nodo superior a tres. En el caso de los seis nodos, el total de infectados es 149,85; con cinco nodos, 148,97; y con cuatro nodos, 141,57. Por otro lado, con tres nodos, el total de infectados es 82,39, con dos nodos, 13,95; y con un nodo, 2,96. El modelo señala el consiguiente problema, si las medidas de distanciamiento social no se suspenden escalonadamente, y se realiza una estrecha vigilancia de los casos localizados, puesto que la relación entre el promedio de enlaces por nodo y el número de personas infectadas parece que tiene forma de "s" y no es lineal.
Subject(s)
Humans , Pneumonia, Viral/transmission , Communicable Disease Control , Family Characteristics , Coronavirus Infections/transmission , Betacoronavirus , Pneumonia, Viral/prevention & control , Pneumonia, Viral/epidemiology , Social Isolation , Brazil/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , COVID-19 , Models, BiologicalABSTRACT
Resumo Objetivo descrever os perfis de interesse de busca de informações na internet sobre termos relacionados à epidemia da Covid-19 no Brasil. Métodos realizou-se uma pesquisa quantitativa exploratória usando o Google Health Trends; foram analisados dados diários de interesse, definido como probabilidade de consulta (Pr), sobre 23 termos nas buscas realizadas por usuários conectados no Brasil no período de 1º de janeiro a 9 de abril de 2020. Resultados o pico de interesse (Pr=0,0651) pelo tema coronavirus ocorreu em 21 de março; o interesse pelos temas uso de máscaras (Pr=0,0041), distanciamento social (Pr=0,0043) e higienização das mãos com álcool em gel (Pr=0,0037) foi superior ao interesse pelos temas etiqueta respiratória (Pr=0,0010) e higienização das mãos com água e sabão (Pr=0,0005). Conclusão a diferença de interesse pelos temas relacionados ao combate à Covid-19 foi expressiva e pode orientar novas estratégias de divulgação de informações em saúde.(AU)
Resumen Objetivos describir los perfiles de las consultas de búsqueda basadas en la Internet sobre términos relacionados a la epidemia del Covid-19 en Brasil. Métodos Se realizó una investigación cuantitativa y exploratoria usando Google Health Trends. Analizamos datos diarios de interés, definidos como probabilidad de consulta (Pr), en 23 términos en búsquedas realizadas por usuarios conectados en Brasil del 1º de enero de 2020 al 9 de abril 2020. Resultados el mayor interés (Pr = 0,0651) en el coronavirus ocurrió el 21 de marzo. El interés en los temas uso de máscaras (Pr = 0,0041), distancia social (Pr = 0,0043) e higiene de las manos con alcohol gel (Pr = 0,0037) es superior al interés en etiqueta respiratoria (Pr = 0,0010) e higiene de las manos con agua y jabón (Pr = 0,0005). Conclusión la diferencia de interés en los temas relacionados con la lucha contra el Covid-19 es sustancial y puede orientar nuevas estrategias de divulgación de información en salud.(AU)
Abstract Objective to describe profiles of interest of web search queries related to the Covid-19 epidemic in Brazil. Methods this was a quantitative and exploratory study using Google Health Trends. We analyzed daily data of interest, defined as search probability (Pr), in 23 terms in searches performed by users connected in Brazil from January 1 to April 9, 2020. Results the peak in interest (Pr=0.0651) on the theme of coronavirus occurred on March 21. Interest in use of face masks (Pr=0.0041), social distancing (Pr=0.0043) and hand hygiene with alcohol gel (Pr=0.0037) was greater than interest in respiratory etiquette (Pr=0.0010) and hand hygiene with soap and water (Pr=0.0005). Conclusion the difference in interest in issues related to combating Covid-19 was substantial and can guide new strategies for disseminating health information.(AU)
Subject(s)
Humans , Coronavirus Infections/epidemiology , Information Seeking Behavior , Health Communication , Brazil/epidemiology , Epidemiology, DescriptiveABSTRACT
BACKGROUND AND OBJECTIVE: Choroidal thickness (CT) measurements from eyes with similar areas of macular geographic atrophy (GA) secondary to age-related macular degeneration (AMD) and Stargardt disease (STGD) were compared to determine whether GA from different diseases had a similar or different effect on the underlying subfoveal choroid. PATIENTS AND METHODS: Eyes with the diagnosis of central GA secondary to STGD and AMD were matched, with subfoveal CT measurements obtained from the central B-scan using an enhanced depth imaging protocol. The area of GA was measured using fundus autofluorescence (FAF) imaging. AMD eyes were divided into those with and without reticular pseudodrusen. RESULTS: A total of 22 eyes of 22 patients were included in the STGD and AMD groups and were matched with respect to the area of GA. The mean age of the STGD patients was 48.9 years (standard deviation [SD]=17.1), and the mean age was 81.8 years (SD=6.2) for the AMD patients. Mean area measurements of GA for the STGD and AMD groups were 5.4 mm2 (SD=4.1) and 5.1 mm2 (SD=4.0), respectively (P=.83). After adjusting for age and axial length, eyes with STGD had a mean CT measurement greater than the AMD eyes (336.1 µm vs. 198.1 µm, respectively; P=.039). However, this difference was driven by AMD eyes with reticular pseudodrusen (RPD) and by a single Stargardt case with a very thick choroid. Eyes with RPD had statistically thinner subfoveal CT measurements when compared with all other groups. CONCLUSION: A small but statistically significant increase in the CT of STGD eyes was observed when compared with normal controls and AMD eyes without RPD. However, this small increase in CT was driven by a single case with a markedly thicker choroid within the STGD group, so it is unlikely that a clinically significant difference exists. However, AMD eyes with GA and RPD had significantly thinner subfoveal CT measurements.
Subject(s)
Choroid/pathology , Geographic Atrophy/diagnosis , Macular Degeneration/congenital , Macular Degeneration/complications , ATP-Binding Cassette Transporters/genetics , Adult , Aged , Aged, 80 and over , DNA Mutational Analysis , Fluorescein Angiography , Geographic Atrophy/etiology , Humans , Macular Degeneration/genetics , Middle Aged , Organ Size , Polymerase Chain Reaction , Prospective Studies , Retinal Drusen/diagnosis , Retinal Drusen/etiology , Stargardt Disease , Tomography, Optical Coherence , Young AdultABSTRACT
The association between the growth of geographic atrophy (GA) and a single nucleotide polymorphism (SNP) in the complement factor I (CFI) locus was investigated in the COMPLETE trial. Growth of GA at 52 weeks in eyes without the CFI at-risk allele was slightly faster than the growth in eyes with the CFI at-risk allele (P ≥ .72). The authors of the current study found that in contrast to the faster growth rate reported in CFI-positive eyes from the MAHALO trial, the CFI positive eyes in the COMPLETE trial did not grow faster, and this analysis included 24 eyes that met the MAHALO eligibility criteria.
Subject(s)
Complement Factor I/genetics , Geographic Atrophy/genetics , Geographic Atrophy/pathology , Polymorphism, Single Nucleotide , Complement C2 , Complement C3 , Complement Factor H/genetics , Fluorescein Angiography , Genotyping Techniques , Humans , Tomography, Optical CoherenceABSTRACT
BACKGROUND AND OBJECTIVE: To compare subfoveal choroidal thickness (CT) measurements in eyes with nonexudative age-related macular degeneration (AMD) in the presence or absence of reticular pseudodrusen (RPD). PATIENTS AND METHODS: Subfoveal CT measurements obtained from patients with AMD enrolled in the COMPLETE study (30 drusen-only eyes and 30 eyes with geographic atrophy [GA]) were compared with an age-distributed normal control group. Multimodal images were evaluated to detect the presence of RPD. RESULTS: After controlling for age and axial length, the mean CT was significantly thinner in the GA group with RPD (213.7 ± 53.1 µm) than in the GA group without RPD (335.3 ± 123.2 µm; P = .001). The mean CT in the GA group without RPD was not statistically different from the mean CT in the normal control group (P = .076) or the drusen group without RPD (P = .45). In eyes without RPD, there was a correlation between the increasing size of GA and a decrease in CT measurements. CONCLUSION: Subfoveal choroidal thinning in eyes with nonexudative AMD was associated with the presence of RPD. In the absence of RPD, CT only decreased as the size of GA increased.
Subject(s)
Choroid/pathology , Geographic Atrophy/diagnosis , Retinal Drusen/diagnosis , Adult , Aged , Aged, 80 and over , Female , Fluorescein Angiography , Fovea Centralis , Humans , Macular Degeneration/diagnosis , Male , Middle Aged , Multimodal Imaging , Organ Size , Tomography, Optical Coherence , Visual Acuity , Young AdultABSTRACT
BACKGROUND AND OBJECTIVE: To compare the measurements and growth rates of geographic atrophy (GA) secondary to age-related macular degeneration (AMD) obtained using different imaging modalities. PATIENTS AND METHODS: Thirty patients with AMD and GA measuring from 1.25 mm² to 18 mm² based on spectral-domain optical coherence tomography (SD-OCT) fundus imaging were enrolled. Imaging was performed at baseline and at follow-up months 3, 6, 9, and 12, including autofluorescence (AF) imaging with a fundus camera-based flash system (TRC-50DX; Topcon Medical Systems, Oakland, NJ; AF excitation λ: 535-585 nm; detection λ: 605-715 nm), AF and fluorescein angiography (FA) imaging with a confocal scanning laser ophthalmoscopy (SLO) system (Spectralis; Heidelberg Engineering, Heidelberg, Germany; AF excitation λ: 488 nm; detection λ: > 500 nm), and SD-OCT en face imaging (Cirrus; Carl Zeiss Meditec, Dublin, CA). RESULTS: Average baseline square root measurements and enlargement rates of square root areas appeared similar across all modalities; 0.2 mm was the largest difference between any pair of measurement means. The intraclass correlation coefficients (ICC) were essentially equal to 1 for all comparisons of area measurements but were lower for growth rates than area measurements. Comparison of 26-week average enlargement rates showed no significant difference between the SLO AF image and enhanced SD-OCT en face image (mean difference: 0.01 mm; SD: 0.10; P = .70). CONCLUSION: Agreement among all imaging modalities in measuring the areas of GA at baseline diminished when the growth rates of GA were compared over 26 weeks, likely because each imaging technique identifies different anatomic features along the border of GA, which may appear similar but change at different rates.
Subject(s)
Geographic Atrophy/diagnosis , Multimodal Imaging , Retina/pathology , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Complement Inactivating Agents/therapeutic use , Double-Blind Method , Fluorescein Angiography , Geographic Atrophy/classification , Geographic Atrophy/drug therapy , Humans , Middle Aged , Ophthalmoscopy , Optical Imaging , Prospective Studies , Tomography, Optical CoherenceABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate subfoveal choroidal thickness (CT) and the extent of outer retinal disruption in patients with macular telangiectasia type 2 (MacTel2) compared with healthy eyes. PATIENTS AND METHODS: In this prospective, observational, cohort study, 62 patients (62 eyes) with Mac-Tel2 and 130 healthy controls (130 eyes) underwent a complete ophthalmological examination, spectral-domain optical coherence tomography (SD-OCT) imaging, and axial length measurements. Patients in the study group also underwent color fundus photography, fundus autofluorescence, and fluorescein angiography. En face SD-OCT imaging was used to assess abnormalities involving the photoreceptor inner segment/outer segment/ellipsoid zone (IS/OS/EZ). RESULTS: After adjusting for age and axial length, the authors found that eyes with MacTel2 had a mean CT measurement that was greater than control eyes (P = .007). There was a negative correlation between the visual acuity and the area of IS/OS/EZ damage (P = .009), but no statistically significant correlation was seen between CT and the area of IS/OS/EZ damage. CONCLUSION: Eyes with MacTel2 were found to have thicker CT measurements than control eyes. While the extent of IS/OS/EZ disruption correlated with the loss of visual acuity, this damage did not correlate with CT measurements.
Subject(s)
Choroid/pathology , Photoreceptor Cells, Vertebrate/pathology , Retinal Telangiectasis/complications , Tomography, Optical Coherence , Adult , Aged , Aged, 80 and over , Axial Length, Eye/pathology , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Male , Middle Aged , Organ Size , Prospective Studies , Retinal Telangiectasis/classification , Retinal Telangiectasis/diagnosis , Visual Acuity , Young AdultABSTRACT
A violência interpessoal fatal é um dos principais problemas de saúde pública no Brasil. Para a compreensão desse fenômeno complexo, é necessário esforço interdisciplinar. O objetivo deste artigo é investigar o papel desempenhado pela violência no processo histórico de construção do território no Ceará. O materialismo histórico foi utilizado como matriz teórica para estabelecer uma periodização crítica da violência. A articulação entre modo de produção e superestrutura permitiu uma aproximação da categoria formação social, no contexto do território. Foi possível estabelecer cinco blocos históricos relativamente homogêneos. A violência é um dos principais vetores da constituição do território cearense. Observa-se que esse fenômeno foi transformado em mais uma mercadoria, concreta e simbólica. A proximidade entre o perfil de jovem morto pela violência e o perfil de jovens desempregados não se deve ao acaso. Ambos sobrevivem nas periferias urbanas brasileiras carentes de políticas de proteção social. A persistência do modo de produção capitalista requer esse contingente populacional, que garante o baixo custo da força de trabalho, um dos pilares do desenvolvimento econômico no Ceará...
Fatal interpersonal violence is a major public health problem in Brazil. To understand this complex phenomenon, there is a need for interdisciplinary effort. This article aims to investigate the role played by violence in the historical process of territory formation in Ceará, Brazil. Historical materialism was used as the theoretical matrix to establish a critical periodization of violence. The interconnection between production mode and superstructure enabled us to get closer to the category social formation, in the context of territory. It was possible to establish five historic blocks relatively homogeneous. Violence is one of the major vectors of territory formation in Ceará. It is observed that this phenomenon has been turned into another commodity, concrete and symbolic. The close relation between the profile of a young man killed due to violence and the profile of an unemployed young man is not a matter of chance. Both of them survive in Brazilian urban outskirts lacking social protection policies. The persistence of the capitalist production mode requires this population contingent, which guarantees the low cost of workforce, a pillar of the economic development in Ceará...
Subject(s)
Humans , Male , Female , Adolescent , Primary Health Care , Capitalism , Homicide , Social Welfare , Violence/history , Poverty Areas , Unemployment , Health StrategiesABSTRACT
PURPOSE: To investigate the relationship between drusen areas measured with color fundus images (CFIs) and those with spectral-domain optical coherence tomography (SDOCT). METHODS: Forty-two eyes from thirty patients with drusen in the absence of geographic atrophy were recruited to a prospective study. Digital color fundus images and SDOCT images were obtained at baseline and at follow-up visits at 3 and 6 months. Registered, matched circles centered on the fovea with diameters of 3 mm and 5 mm were identified on both CFIs and SDOCT images. Spectral-domain OCT drusen measurements were obtained using a commercially available proprietary algorithm. Drusen boundaries on CFIs were traced manually at the Doheny Eye Institute Image Reading Center. RESULTS: Mean square root drusen area (SQDA) measurements for the 3-mm circles on the SDOCT images were 1.451 mm at baseline and 1.464 mm at week 26, whereas the measurements on CFIs were 1.555 mm at baseline and 1.584 mm at week 26. Mean SQDA measurements from CFIs were larger than those from the SDOCT measurements at all time points (P = 0.004 at baseline, P = 0.003 at 26 weeks). Changes in SQDA over 26 weeks measured with SDOCT were not different from those measured with CFIs (mean difference = 0.014 mm, P = 0.5). CONCLUSIONS: Spectral-domain OCT drusen area measurements were smaller than the measurements obtained from CFIs. However, there were no differences in the change in drusen area over time between the two imaging modalities. Spectral-domain OCT measurements were considerably more sensitive in assessing drusen area changes.
Subject(s)
Diagnostic Imaging , Retinal Drusen/diagnosis , Tomography, Optical Coherence/methods , Aged , Algorithms , Disease Progression , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of ResultsABSTRACT
PURPOSE: We determined whether the minimum intensity (MI) of the optical coherence tomography (OCT) A-scans within the retina can predict locations of growth at the margin of geographic atrophy (GA) and the growth rate outside the margin. METHODS: The OCT scans were analyzed at baseline and 52 weeks. Expert graders manually segmented OCT images of GA. The 52-week follow-up scans were registered to the baseline scan coordinates for comparison. The OCT MI values were studied within a 180-µm margin around the boundary of GA at baseline. Baseline MI values were compared in areas of progression and nonprogression of the GA, and sensitivity and specificity were assessed for prediction of growth at the margin. Average MI values in the margins were compared to overall growth rates to evaluate the prediction of growth outside the margins. RESULTS: A statistically significant increase in MI (P < 0.05) was seen in areas of growth in 21/24 cases (88%), and 22/24 cases (92%) when the foveal subfield was excluded. Locations of growth within the margins at 52 weeks were predicted with 61% sensitivity and 61% specificity. The MI values correlated significantly with overall growth rate, and high and low growth rate subjects were identified with 80% sensitivity and 64% specificity. CONCLUSIONS: The MI may be increased at the margins of GA lesions before enlargement, which may indicate disruption or atrophy of the photoreceptors in these areas before GA becomes apparent. Increased MI may help predict areas of enlargement of GA, and may relate to overall growth rate and be a useful screening tool for GA. (ClinicalTrials.gov number, NCT00935883.).
Subject(s)
Geographic Atrophy/diagnosis , Photoreceptor Cells, Vertebrate/pathology , Retinal Neurons/pathology , Retinal Pigment Epithelium/pathology , Tomography, Optical Coherence , Bruch Membrane/pathology , Disease Progression , Follow-Up Studies , Humans , Prospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the change in drusen volume following treatment with eculizumab, a systemic inhibitor of complement component 5. PATIENTS AND METHODS: Single-center, prospective, randomized, double-masked clinical trial. Patients were randomized 2:1 to receive intravenous eculizumab or placebo over 26 weeks. MAIN OUTCOME MEASURE: decrease in drusen volume of at least 50% at 26-week follow-up. RESULTS: Mean drusen cube root volumes were 0.49 mm and 0.47 mm (P = .64) at baseline and 0.51 mm and 0.42 mm (P = .17) at 26 weeks in the eculizumab and placebo groups, respectively. In the placebo group, one eye had a decrease in drusen volume of at least 50% and two eyes developed neovascularization through 26 weeks. CONCLUSION: Systemic complement inhibition with eculizumab did not significantly reduce drusen volume. Drusen growth was dependent on the number of complement at-risk alleles. Future trials should consider the use of a composite clinical trial endpoint in which efficacy is defined by the treatment's ability to prevent drusen growth, neovascularization, and the formation of geographic atrophy over 1 year.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Complement C5/antagonists & inhibitors , Endpoint Determination , Geographic Atrophy/drug therapy , Retinal Drusen/drug therapy , Retinal Drusen/pathology , Aged , Double-Blind Method , Female , Fluorescein Angiography , Follow-Up Studies , Geographic Atrophy/diagnosis , Humans , Male , Middle Aged , Prospective Studies , Tomography, Optical Coherence , Treatment Outcome , Visual Acuity/physiologyABSTRACT
PURPOSE: To evaluate the effect of eculizumab, a systemic inhibitor of complement component (C5), on the growth of geographic atrophy (GA) in patients with age-related macular degeneration (AMD). DESIGN: Prospective, double-masked, randomized clinical trial. PARTICIPANTS: Patients with GA measuring from 1.25 to 18 mm(2) based on spectral-domain optical coherence tomography imaging. METHODS: Patients were randomized 2:1 to receive intravenous eculizumab or placebo over 6 months. In the eculizumab treatment arm, the first 10 patients received a low-dose regimen of 600 mg weekly for 4 weeks followed by 900 mg every 2 weeks until week 24, and the next 10 patients received a high-dose regimen of 900 mg weekly for 4 weeks followed by 1200 mg every 2 weeks until week 24. The placebo group was infused with saline. Patients were observed off treatment for an additional 26 weeks. Both normal-luminance and low-luminance visual acuities were measured throughout the study, and the low-luminance deficits were calculated as the difference between the letter scores. MAIN OUTCOME MEASURES: Change in area of GA at 26 weeks. RESULTS: Thirty eyes of 30 patients were enrolled. Eighteen fellow eyes also met inclusion criteria and were analyzed as a secondary endpoint. For the 30 study eyes, mean square root of GA area measurements ± standard deviation at baseline were 2.55 ± 0.94 and 2.02 ± 0.74 mm in the eculizumab and placebo groups, respectively (P = 0.13). At 26 weeks, GA enlarged by a mean of 0.19 ± 0.12 and 0.18 ± 0.15 mm in the eculizumab and placebo groups, respectively (P = 0.96). At 52 weeks of follow-up, GA enlarged by a mean of 0.37 ± 0.22 mm in the eculizumab-treated eyes and by a mean of 0.37 ± 0.21 mm in the placebo group (P = 0.93, 2 sample t test). None of the eyes converted to wet AMD. No drug-related adverse events were identified. CONCLUSIONS: Systemic complement inhibition with eculizumab was well tolerated through 6 months but did not decrease the growth rate of GA significantly. However, there was a statistically significant correlation between the low-luminance deficit at baseline and the progression of GA over 6 months.
