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ABSTRACT Objectives: to analyze factors associated, directly and indirectly, with lower social support of older adults, according to sex. Methods: a cross-sectional study, with 941 older adults from a health micro-region in Minas Gerais. Descriptive and trajectory analyzes were carried out (p

ABSTRACT OBJECTIVE To evaluate the relationship between ambient air pollutants and chronic obstructive pulmonary disease in relatively low-polluted areas in China. METHODS Atmospheric pollutants levels and meteorological data were obtained from January 2016 to December 2020. The medical database including daily hospital admissions for chronic obstructive pulmonary disease (ICD10: J44) was derived from the First Affiliated Hospital of Gannan Medical University. The generalized additive model was used to analyze the percentage change with 95% confidence interval in daily hospital admissions for chronic obstructive pulmonary disease associated with a 10 µg/m3 increase in atmospheric pollutants levels. RESULTS In total, occurred 4,980 chronic obstructive pulmonary disease hospital admissions (not including emergency department visits) during 2016–2020. The mean concentrations of daily PM2.5, PM10, SO2, NO2, O3, and CO were 37.5 μg/m3, 60.1 μg/m3, 18.7 μg/m3, 23.5 μg/m3, 70.0 μg/m3, and 1.2 mg/m3 in Ganzhou. Each 10 µg/m3 increment of PM2.5, PM10, NO2, and O3 were significantly associated with 2.8% (95%CI: 1.0–4.7), 1.3% (95%CI: 0.3–2.4), 2.8% (95%CI: 0.4–5.4), and 1.5% (95%CI: 0.2–2.7) elevation in daily chronic obstructive pulmonary disease hospital admissions. The estimates of delayed effects of PM2.5, PM10, NO2, and O3 were observed at lag6, lag6, lag8, lag1, respectively. The health effects of particulate pollutants (PM2.5 and PM10) may be independent of other pollutants. The adverse effects of air pollutants were more evident in the warm season (May–Oct) than in the cold season (Nov–Apr). CONCLUSION Our study demonstrated that elevated concentrations of atmospheric pollutant (PM2.5, PM10, NO2, and O3), especially particulate pollutants, can be associated with increased daily count of hospital admissions for chronic obstructive pulmonary disease , which may promote further understanding of the potential hazards of relatively low levels of air pollution on chronic obstructive pulmonary disease and other respiratory disorders.

Objective: The objective of this study is to estimate the prevalence of chronic Chagas disease (CCD) in Brazil: in the general population, in women, and in women of childbearing age., Methods: A meta-analysis of the literature was conducted to extract data on the prevalence of CCD in municipalities in Brazil in the 2010-2022 period: in the general population, in women, and in women of childbearing age. Municipal-level CCD indicators available in health information systems were selected. Statistical modeling of the data extracted from the meta-analysis (based on data obtained from information systems) was applied to linear, generalized linear, and additive models., Results: The five most appropriate models were selected from a total of 549 models tested to obtain a consensus model (adjusted R 2 = 54%). The most important predictor was self-reported CCD in the primary health care information system. Zero prevalence was estimated in 1 792 (32%) of Brazil's 5 570 municipalities; in the remaining 3 778 municipalities, average prevalence of the disease was estimated at 3.25% (± 2.9%). The number of carriers of CCD was estimated for the Brazilian population (~3.7 million), for women (~2.1 million) and for women of childbearing age (~590 000). The disease reproduction rate was calculated at 1.0336. All estimates refer to the 2015-2016 period., Conclusions: The estimated prevalence of CCD, especially among women of childbearing age, highlights the challenge of vertical transmission in Brazilian municipalities. Mathematical projections suggest that these estimates should be included in the national program for the elimination of vertical transmission of Chagas disease.

Abstract Introduction: The prediction of post transplantation outcomes is clinically important and involves several problems. The current prediction models based on standard statistics are very complex, difficult to validate and do not provide accurate prediction. Machine learning, a statistical technique that allows the computer to make future predictions using previous experiences, is beginning to be used in order to solve these issues. In the field of kidney transplantation, computational forecasting use has been reported in prediction of chronic allograft rejection, delayed graft function, and graft survival. This paper describes machine learning principles and steps to make a prediction and performs a brief analysis of the most recent applications of its application in literature. Discussion: There is compelling evidence that machine learning approaches based on donor and recipient data are better in providing improved prognosis of graft outcomes than traditional analysis. The immediate expectations that emerge from this new prediction modelling technique are that it will generate better clinical decisions based on dynamic and local practice data and optimize organ allocation as well as post transplantation care management. Despite the promising results, there is no substantial number of studies yet to determine feasibility of its application in a clinical setting. Conclusion: The way we deal with storage data in electronic health records will radically change in the coming years and machine learning will be part of clinical daily routine, whether to predict clinical outcomes or suggest diagnosis based on institutional experience.

ABSTRACT OBJECTIVE To compare two methodological approaches: the multinomial model and the zero-inflated gamma model, evaluating the factors associated with the practice and amount of time spent on leisure time physical activity. METHODS Data collected from 14,823 baseline participants in the Longitudinal Study of Adult Health (ELSA-Brasil – Estudo Longitudinal de Saúde do Adulto ) have been analysed. Regular leisure time physical activity has been measured using the leisure time physical activity module of the International Physical Activity Questionnaire. The explanatory variables considered were gender, age, education level, and annual per capita family income. RESULTS The main advantage of the zero-inflated gamma model over the multinomial model is that it estimates mean time (minutes per week) spent on leisure time physical activity. For example, on average, men spent 28 minutes/week longer on leisure time physical activity than women did. The most sedentary groups were young women with low education level and income CONCLUSIONS The zero-inflated gamma model, which is rarely used in epidemiological studies, can give more appropriate answers in several situations. In our case, we have obtained important information on the main determinants of the duration of leisure time physical activity. This information can help guide efforts towards the most vulnerable groups since physical inactivity is associated with different diseases and even premature death.

OBJETIVO: Analisar a literatura nacional e internacional sobre validade de métodos de relacionamentos nominais de base de dados em saúde, com ênfase nas medidas de aferição da qualidade dos resultados. MÉTODOS: Revisão sistemática de estudos de coorte, caso-controles e seccionais que avaliaram a qualidade dos métodos de relacionamento probabilístico de base de dados em saúde. Foi utilizada metodologia Cochrane para revisões sistemáticas. As bases consultadas foram as mais amplamente utilizadas: Medline, LILACS, Scopus, SciELO e Scirus. Não foi utilizado filtro temporal e os idiomas considerados foram: português, espanhol, francês e inglês. RESULTADOS: As medidas sumárias da qualidade dos relacionamentos probabilísticos foram a sensibilidade, a especificidade e o valor preditivo positivo. Dos 202 estudos identificados, após critérios de inclusão, foram analisados 33 artigos. Apenas seis apresentaram dados completos sobre as medidas-sumárias de interesse. Observam-se como principais limitações a ausência de revisor na avaliação dos títulos e dos resumos dos artigos e o não-mascaramento da autoria dos artigos no processo de revisão. Estados Unidos, Reino Unido e Nova Zelândia concentraram as publicações científicas neste campo. Em geral, a acurácia dos métodos de relacionamento probabilístico de bases de dados variou de 74% a 98% de sensibilidade e 99% a 100% de especificidade. CONCLUSÕES: A aplicação do relacionamento probabilístico a bases de dados em saúde tem primado pela alta sensibilidade e uma maior flexibilização da sensibilidade do método, mostrando preocupação com a precisão dos dados a serem obtidos. O valor preditivo positivo nos estudos aponta alta proporção de pares de registros verdadeiramente positivos. A avaliação da qualidade dos métodos empregados tem se mostrado indispensável para validar os resultados obtidos nestes tipos de estudos, podendo ainda contribuir para a qualificação das grandes bases de dados em saúde disponíveis no País.OBJETIVO: Analizar la literatura nacional e internacional sobre validez de métodos de relacionamientos nominales de base de datos en salud, con énfasis en las medidas de confirmación de la calidad de los resultados. MÉTODOS: Revisión sistemática de estudios de cohorte, caso-controles y seccionales que evaluaron la calidad de los métodos de relacionamiento probabilístico de base de datos en salud. Fue utilizada metodología Cochrane para revisiones sistemáticas. Las bases consultadas fueron las más ampliamente utilizadas: Medline, LILACS, Scopus, SciELO y Scirus. No fue utilizado filtro temporal y los idiomas considerados fueron: portugués, español, francés e inglés. RESULTADOS: Las medidas rápidas de la calidad de los relacionamientos probabilísticos fueron la sensibilidad, la especificidad y el valor predictivo positivo. De los 202 estudios identificados, posterior a los criterios de inclusión, fueron analizados 33 artículos. Sólo seis presentaron datos completos sobre las medidas-rápidas de interés. Se observan como principales limitaciones la ausencia de revisor en la evaluación de los títulos y de los resúmenes de los artículos y el no-ocultamiento de la autoría de los artículos en el proceso de revisión. Estados Unidos, Reino Unido y Nueva Zelandia concentraron las publicaciones científicas en este campo. En general, el perfeccionamiento de los métodos de relacionamiento probabilístico de bases de datos varió de 74% a 98% de sensibilidad y 99% a 100% de especificidad. CONCLUSIONES: La aplicación de relacionamiento probabilístico a bases de datos en salud se ha priorizado por la alta sensibilidad y mayor flexibilización de la sensibilidad del método, mostrando preocupación con la precisión de los datos que se obtendrán. El valor predictivo positivo en los estudios apunta alta proporción de pares de registros verdaderamente positivos. La evaluación de la calidad de los métodos empleados se ha mostrado indispensable para validar los resultados obtenidos en estos tipos de estudios, pudiendo aún contribuir para la calificación de las grandes bases de datos en salud disponibles en el País.OBJECTIVE: To analyze both national and international literature on validity of record linkage procedure of health databases focusing on quality assessment of results. METHODS: A systematic review of cohort, case-control, and cross-sectional studies that evaluated quality of probabilistic record linkage of health databases was conducted. Cochrane methodology of systematic reviews was used. The following databases were widely searched: Medline, LILACS, Scopus, SciELO and Scirus. A time filter was not applied and articles were searched in the following languages: Portuguese, Spanish, French and English. RESULTS: Summary measures of the quality of probabilistic record linkage were sensitivity, specificity, and positive predictive value. There were identified 202 studies, and after applying the inclusion criteria, a total of 33 articles were reviewed. Only six had complete data on the summary measures of interest. The main limitations were: no reviewer to evaluate titles and abstracts; and no blinding of the article's authors in the review process. Most scientific publications in this field were from the United States, United Kingdom, and New Zealand. Overall, the accuracy of probabilistic record linkage of databases ranged from 74% to 98% sensitivity and 99% to 100% specificity. CONCLUSIONS: Probabilistic record linkage of health databases has notably been characterized by high sensitivity and greater flexibility of the procedure's sensitivity, indicating concern with data accuracy. The positive predictive value in studies shows a high proportion of truly positive record pairs. The quality assessment of these procedures has been proved essential for validating the results obtained in these studies, and can also contribute to improve large health databases available in Brazil.

OBJETIVO: Caracterizar la frecuencia y tipo de uso de teorías o modelos citados en artículos publicados en una revista latinoamericana de salud publica entre los años 2000 y 2004. MÉTODOS: Se escogió la Revista de Saúde Pública por su historia de publicación periódica sin interrupción e impacto actual en la comunicación científica del área. Se aplicó un procedimiento estándar para leer los artículos y clasificarlos en una tipología arbitraria de cuatro niveles según la profundidad del uso dado a los referentes teóricos o modelos citados en los textos para describir asuntos o problemas abordados, formular métodos y discutir a rigor los hallazgos comunicados. RESULTADOS: Se leyeron 482 artículos: 421 (87%) investigaciones, 42 (9%) revisiones o especiales y 19 (4%) textos de opinión o reflexión. En las 421 investigaciones, 286 (68%) tuvieron enfoque cuantitativo, 110 (26%) cualitativo y 25 (6%) mixtos. La cita de teorías o modelos fue infrecuente; 90 (19%) artículos revisados citan algun referente. Según la profundidad de uso 29 (6%) de los 90 fueron tipo I, 9 (1,9%) tipo II, 6 (1,3%) tipo III y 46 (9,5%), tipo IV. CONCLUSIONES: La citación de modelos fue nueve veces más frecuente que la de alguna teoría; el uso ideal, el tipo IV, ocurrió en apenas uno de cada diez artículos analizados. Hay relevancia de explicitar los marcos teóricos y modelos usados al abordar temas, formular hipótesis, diseñar métodos y discutir hallazgos en las contribuciones de las revistas científicas del área.OBJETIVO: Caracterizar a freqüência e tipo de uso de teorias ou modelos citados em artigos publicados em uma revista latino-americana de saúde pública entre os anos 2000 e 2004. MÉTODOS: A Revista de Saúde Pública foi escolhida por sua história de publicação ininterrupta e atual impacto na comunicação científica da área. Foi aplicado um procedimento padrão para ler e classificar os artigos de acordo com tipologia de quatro níveis, segundo a profundidade de uso dado aos referenciais teóricos ou modelos citados nos textos para descrever assuntos ou problemas abordados, formular métodos e discutir a rigor os achados comunicados. RESULTADOS: Foram lidos 482 artigos: 421 (87%) investigações, 42 (9%) revisões ou especiais e 19 (4%) textos de opinião ou reflexão. Nas 421 investigações, 286 (68%) tiveram enfoque quantitativo, 110 (26%) qualitativo e 25 (6%) mistos. A menção a teorias ou modelos não foi freqüente; apenas 90 (19%) dos artigos revisados citavam alguma teoria ou modelo. Segundo a profundidade de uso, 29 (6%) dos 90 foram tipo I, 9 (1,9%) tipo II, 6 (1,3%) tipo III e 46 (9,5%), tipo IV. CONCLUSÕES: A citação de modelos foi nove vezes mais freqüente do que de alguma teoria; o uso ideal, de tipo IV, ocorreu em apenas um de cada dez artículos analisados. É relevante explicitar os marcos teóricos e modelos usados ao abordar temas, formular hipóteses, desenhar métodos e discutir achados nas contribuições das revistas científicas da área.OBJECTIVE: To characterize frequency and type of use of theories or models on papers of a Latin-American journal in public health between 2000 and 2004. METHODS: The Revista de Saúde Pública was chosen because of its history of periodic publication without interruption and current impact on the scientific communication of the area. A standard procedure was applied for reading and classifying articles in an arbitrary typology of four levels, according to the depth of the use of models or theoretical references to describe problems or issues, to formulate methods and to discuss results. RESULTS: Of 482 articles included, 421 (87%) were research studies, 42 (9%) reviews or special contributions and 19 (4%) opinion texts or assays . Of 421 research studies, 286 (68%) had a quantitative focus, 110 (26%) qualitative and 25 (6%) mixed. Reference to theories or models is uncommon, only 90 (19%) articles mentioned a theory or model. According to the depth of the use, 29 (6%) were classified as type I, 9 (2%) as type II, 6 (1.3%) were type III and the 46 remaining texts (9.5%) were type IV. CONCLUSIONS: Reference to models was nine-fold more frequent than the use of theoretical references. The ideal use, type IV, occurred in one of every ten articles studied. It is of relevance to show theoretical and models frames used when approaching topics, formulating hypothesis, designing methods and discussing findings in papers.

OBJECTIVE: To determine health care costs and economic burden of epidemiological changes in diseases related to tobacco consumption. METHODS: A time-series analysis in Mexico (1994-2005) was carried out on seven health interventions: chronic obstructive pulmonary diseases, lung cancer with and without surgical intervention, asthma in smokers and non-smokers, full treatment course with nicotine gum, and full treatment course with nicotine patch. According with Box-Jenkins methodology, probabilistic models were developed to forecast the expected changes in the epidemiologic profile and the expected changes in health care services required for selected interventions. Health care costs were estimated following the instrumentation methods and validated with consensus technique. RESULTS: A comparison of the economic impact in 2006 vs. 2008 showed 20-90% increase in expected cases depending on the disease (pOBJETIVO: Avaliar os custos da atenção médica a doenças associadas ao tabagismo e o impacto econômico das mudanças epidemiológicas. MÉTODOS: Análise de série temporal no México (1994-2005) de sete intervenções médicas em relação a: doença pulmonar obstrutiva crônica, câncer de pulmão com e sem intervenção cirúrgica, asma bronquial em fumantes e não-fumantes, tratamento com adesivos para deixar de fumar, tratamento com goma de mascar. As mudanças epidemiológicas esperadas e as necessidades financeiras para atender a demanda de serviços foram avaliadas pelos modelos probabilísticos de Box-Jenkins. Os custos foram determinados de acordo com método de instrumentação e a técnica de consenso. RESULTADOS: A comparação do impacto das mudanças epidemiológicas previstas para 2006 e 2008 mostrou incremento de 20% a 90%, dependendo do tipo de intervenção. O incremento nos custos da atenção médica foi de 25% a 93%. Há indícios que a demanda de serviços de saúde para as intervenções investigadas continuarão aumentando. CONCLUSÕES: Em termos econômicos, o aumento na quantidade de casos esperados refletem um fenômeno de competição interna em relação ao uso dos recursos adicionais entre atividades de promoção e prevenção da saúde relacionada ao tabagismo. Se não houver mudanças nos programas de prevenção, haverão desafios econômicos de alto impacto no financiamento dos sistemas de saúde.

OBJETIVO; Investigar a influência de fatores socioeconômicos e demográficos relativos à saúde, bem como os fatores ligados às atividades sociais e à avaliação subjetiva da saúde sobre a capacidade funcional dos idosos. MÉTODOS: Estudo transversal, integrante de estudo multicêntrico, em amostra representativa do município de São Paulo, realizado em 1989. A capacidade funcional foi avaliada através da escala de atividades da vida diária pessoal e instrumental e investigada como variável dicotômica: ausência de dependência - incapacidade/dificuldade em nenhuma das atividades versus presença de dependência moderada/grave - incapacidade/dificuldade em 4 ou mais atividades. Análise de regressão logística múltipla foi aplicada aos fatores hierarquicamente agrupados. RESULTADOS: As características que se associaram com a dependência moderada/grave foram analfabetismo, ser aposentado, ser pensionista, ser dona de casa, não ser proprietário da moradia, ter mais de 65 anos, ter composição familiar multigeracional, ter sido internado nos últimos 6 meses, ser "caso" no rastreamento de saúde mental, não visitar amigos, ter problemas de visão, ter história de derrame, não visitar parentes e ter avaliação pessimista da saúde ao se comparar com seus pares. CONCLUSÕES: As características identificadas que se associaram à dependência moderada/grave sugerem uma complexa rede causal do declínio da capacidade funcional. Pode-se supor, entretanto, que ações preventivas especificamente voltadas para certos fatores podem propiciar benefícios para o prolongamento do bem estar da população idosa.OBJECTIVE: To investigate the impact of health-related demographic and socioeconomic factors, as well as the impact of factors associated to social activity and the subjective health evaluation on the functional status of elderly people. METHODS: A cross-sectional multicentric study was conducted in a representative population sample in the city of São Paulo, Brazil, in 1989. Functional status was evaluated using a scale of activities of personal and instrumental daily living. It was studied as a dichotomous variable: absence of dependency - disability/difficulty in none of the activities in contrast with moderate/severe dependency - disability/difficulty in 4 or more activities. Multiple regression analysis was applied to hierarchically clustered factors. RESULTS: Those with the following features were more associated to moderate/severe dependency: illiterate, retired, pensioner, housekeeper, living in a rented home, age over 65 years, multigenerational family composition, hospitalization in the last 6 months, mental health screening case, no visiting friends, and having a pessimistic perception of his/her own health when compared to their peers. CONCLUSIONS: The identified features associated to moderate/severe dependency suggest a complex net of causes for the declining functional status. However, one can assume that preventive measures directed to specific factors can benefit these population by improving their well-being.

Este é um artigo introdutório sobre análise de séries temporais, onde se pretende apresentar, de maneira sumária, alguns modelos estatísticos mais utilizados em análise de séries temporais . Uma série temporal, também denominada série histórica, é uma seqüência de dados obtidos em intervalos regulares de tempo durante um período específico. Na análise de uma série temporal, primeiramente deseja-se modelar o fenômeno estudado para, a partir daí, descrever o comportamento da série, fazer estimativas e, por último, avaliar quais os fatores que influenciaram o comportamento da série, buscando definir relações de causa e efeito entre duas ou mais séries. Para tanto, há um conjunto de técnicas estatísticas disponíveis que dependem do modelo definido (ou estimado para a série), bem como do tipo de série analisada e do objetivo do trabalho. Para analise de tendências, podem se ajustar modelos de regressão polinomial baseados na série inteira ou em vizinhança de um determinado ponto. Isso também pode ser realizado com funções matemáticas. Define-se como um fenômeno sazonal aquele que ocorre regularmente em períodos fixos de tempo e, se existir sazonalidade dita determinística na série, podem-se utilizar modelos de regressão que incorporem funções do tipo seno ou cosseno à variável tempo. Os modelos auto-regressivos formam outra classe de modelos. Na análise do comportamento de uma série histórica livre de tendência e de sazonalidade podem ser utilizados modelos auto-regressivos (AR) ou que incorporem médias móveis (ARMA). Quando há tendência, utilizam-se os modelos auto-regressivos integrados de médias móveis (ARIMA) e, para incorporar o componente de sazonalidade, utilizam-se os modelos SARIMA. Por último há os modelos lineares generalizados. Neste grupo de modelos estatísticos, a variável resposta é um processo de contagem e as variáveis independentes são variáveis candidatas a explicar o comportamento da série ao longo do tempo. Estes modelos são indicados quando as variáveis em estudo não têm aderência à distribuição normal, principalmente pelo fato de serem processos de contagem . Estes modelos compõem um grupo de distribuições de probabilidades conhecido como família exponencial de distribuições que englobam diversas funções aditivas, como a regressão linear, de Poisson, logística, log-linear etc. Os modelos aditivos generalizados são uma extensão desta classe de modelos, nos quais cada variável independente analisada não entra no modelo com o seu valor, mas sim, adotando uma função não paramétrica de forma não especificada, estimada a partir de curvas de alisamento.A time series, also denominated historical series, is a sequence of data obtained in regular intervals of time during a specific period. In the analysis of a time series, one first wants to model the study phenomenon and, from this, to describe the behaviour of the series, to make estimates, and, in the end, to evaluate the factors that may have influenced the behaviour of the series, with the objective of defining cause-effect relationships between two or more series. For this, there is a set of available statistical techniques which depend upon the defined model (or that estimated for the series), the type of the study series, and of the objective of the work. To analyse trends, it is possible to adjust polynomial regression models based on the whole series or on the neighbourhood of a specific point. This can also be done with mathematical functions. A seasonal phenomenon is defined as the one that occurs regularly in fixed periods of time and, if there is seasonality considered as deterministic in the series, one can use regression models which include functions like seno or cosseno to the variable time. In the analysis of the behaviour of a time series without trend and seasonality, the auto-regressive models (AR) or models which incorporate moving averages (ARMA) can be used. When trend is present, one can use auto-regressive models integrated with moving averages (ARIMA) and to incorporate the seasonality component the SARIMA models are used. The generalized linear models constitute another class of models. In this group of statistical models, the response variable is a counting process and the independent variables are those which are candidates to explain the behaviour of the series throughout the time. This class of models is indicated when the study variables do not follow the Normal distribution, mainly because they are counting processes. These models represent a group of probability distributions known as exponential family of distributions that incorporates many additive functions like the linear regression, Poisson, logistic, log-linear, etc. The generalized additive models are an extension of this class of models, in which each independent variable analysed does not enter in the model with its own value, but adopting a non parametric function in a non specific manner, which is estimated from smoothing curves.

INTRODUCTION: The evolution of virulence in host-parasite relationships has been the subject of several publications. In the case of HIV virulence, some authors suggest that the evolution of HIV virulence correlates with the rate of acquisition of new sexual partners. In contrast some other authors argue that the level of HIV virulence is independent of the sexual activity of the host population. METHODS: Provide a mathematical model for the study of the potential influence of human sexual behaviour on the evolution of virulence of HIV is provided. RESULTS: The results indicated that, when the probability of acquisition of infection is a function both of the sexual activity and of the virulence level of HIV strains, the evolution of HIV virulence correlates positively with the rate of acquisition of new sexual partners. CONCLUSION: It is concluded that in the case of a host population with a low (high) rate of exchange of sexual partners the evolution of HIV virulence is such that the less (more) virulent strain prevails.INTRODUÇÃO: A evolução da virulência na relação hospedeiro-parasita tem sido objeto de várias publicações. No caso do HIV, alguns autores sugerem que a evolução da virulência do HIV correlaciona-se com a taxa de aquisição de novos parceiros sexuais. Por outro lado, outros autores argumentam que o nível de virulência do HIV é independente da atividade sexual da população hospedeira. MÉTODOS: Propõe-se um modelo matemático para estudar a influência potencial que o comportamento sexual humano possa ter na evolução da virulência do HIV. RESULTADOS: Os resultados indicam que, quando a probabilidade de aquisição da infecção pelo HIV é uma função tanto da atividade sexual da população humana quanto da virulência das cepas de HIV, a evolução da virulência do HIV correlaciona-se positivamente com a taxa de aquisição de novos parceiros sexuais. CONCLUSÃO: Concluiu-se que no caso de uma população hospedeira com uma baixa (alta) taxa de troca de parceiros sexuais a evolução da virulência do HIV é tal que a cepa menos (mais) virulenta predomina.

INTRODUCTION: The evolution of virulence in host-parasite relationships has been the subject of several publications. In the case of HIV virulence, some authors suggest that the evolution of HIV virulence correlates with the rate of acquisition of new sexual partners. In contrast some other authors argue that the level of HIV virulence is independent of the sexual activity of the host population. METHODS: Provide a mathematical model for the study of the potential influence of human sexual behaviour on the evolution of virulence of HIV is provided. RESULTS: The results indicated that, when the probability of acquisition of infection is a function both of the sexual activity and of the virulence level of HIV strains, the evolution of HIV virulence correlates positively with the rate of acquisition of new sexual partners. CONCLUSION: It is concluded that in the case of a host population with a low (high) rate of exchange of sexual partners the evolution of HIV virulence is such that the less (more) virulent strain prevails.

Dois modelos estatísticos são propostos para estimar os casos de aids no Brasil já diagnosticados e ainda não notificados até o primeiro semestre de 1996, para as diversas categorias de exposição. O primeiro considerou a distribuição do atraso de notificação como uma função de sobrevida, com dados censurados à direita, que foi estimada a partir do método de Kaplan-Meyer. O segundo ajusta uma regressão de Poisson a uma tabela de contingência onde cada célula representa o número de casos diagnosticados no semestre e notificados com um determinado atraso. Precedendo o ajuste desta regressão, utilizou-se um modelo aditivo generalizado para identificar uma função que ajuste melhor que um modelo linear as relações funcionais em questão. As estimativas obtidas foram comparadas com as notificações ocorridas entre o segundo semestre de 1996 e o primeiro semestre de 1997. O confronto entre as estimativas fornecidas pela regressão de Poisson e o número de casos oficialmente notificados sugere uma possível mudança no comportamento do padrão de notificação. O número de casos oficialmente notificados encontra-se bem próximo à epidemia real, provavelmente devido à distribuição gratuita de medicamentos. As estimativas do modelo de sobrevida, que não leva em consideração mudanças no nível da epidemia nos diversos semestres de diagnóstico, tendem a uma subestimação das categorias que estão em crescimento.We estimated the number of AIDS cases in Brazil from official statistics, after correcting for delays in reporting, by the use of two statistical models. First, we fitted a Kaplan-Meyer survival model with right censoring to the distribution of reporting delays. The second approach is based on a Poisson regression model which was fitted to the contingency table having as one dimension the number of AIDS cases diagnosed per calendar time and the other dimension the amount of delay in reporting. Before the latter approach, we explored, by the use of generalized additive models (GAM), the search for convenient smoothing functions that fit the observed functional relationships in question. The estimates we obtained were then compared to the cases actually reported in the second semester of 1996 and in the first semester of 1997. Comparing the observed number of cases and the predicted figures by Poisson regression, a new reporting pattern seems to start to take place. The official reported number of AIDS cases is very close to the actual epidemic, probably due to government policies of free distribution of medication. Survival models that do not account for calendar time changes in the number of diagnosed AIDS cases in each semester seem to underestimate the behavior of the disease in exposure categories where transmission is increasing.

Abordagem da questão da validade dos estudos epidemiológicos. Distinguem-se seis tipos de validade. Na validade conceitual enfocam-se os elementos que sustentam a construção de um modelo teórico explicativo do fenômeno de interesse, articulado no plano do discurso e conceitos abstratos. Na validade operacional discutem-se os processos nos quais os conceitos que compõem as diferentes dimensões do modelo teórico são reduzidos a variáveis e indicadores, viabilizando sua instrumentação no nível empírico. À apresentação da validade de domínio, levanta-se a questão da intercambialidade dos indivíduos da população alvo e da população de estudo como sustentação para a generalização dos resultados. A validade de comparação dos grupos de estudo gira em torno da identificação das circunstâncias que rompem a estrutura de comparabilidade, a saber, a situação de confusão e a exclusão seletiva de elementos. À abordagem da validade de informação, aprofundam-se os problemas referentes à aferição/mensuração e os conseqüentes viéses. Visando algumas diretrizes para avaliação da validade de informação, explora-se os fundamentos das relações temporais envolvendo as ocorrências e os processos de coleta. Por fim, apresentam-se algumas importantes questões relacionadas à escolha e validade de especificação do modelo estatístico, bem como comentários sobre as estratégias mais utilizadas na seleção de variáveis e diagnóstico de modelo. Na parte final, sustenta-se que um enfrentamento sistemático das questões de validade pode servir como um dos pilares para a construção do conhecimento em epidemiologia.The article outlines several validity issues in epidemiological studies. Six types of validity are covered. Conceptual validity concerns the elements sustaining a theoretical explanatory model, which, by definition, exists only on an abstract and discursive level. Operational validity concerns the processes by which concept-pertaining dimensions at a theoretical level are reduced to variables and indicators, enabling empirical testing. In validity of domain, focus is shed on the exchangeability between subjects of the target population and those of the study population as a basis for generalizing results. Comparison validity concerns the identification of circumstances that rupture the comparability structure between groups, namely, confounding and selective exclusion of subjects. Information validity relates to data collection and ensuing biases. Attention is drawn to the problems of timing and order of measurement related to events and data collection procedures. Finally, focus is placed on some important issues related to specification validity of statistical models, identifying guidelines for selecting those models. In the final part, systematic handling of validity issues is contended as a possible building block for attaining knowledge in epidemiology.

Objective: to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color., Method: an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units., Results: the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively)., Conclusion: there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

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Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Using a lagged polynomial regression model, which used COVID-19 data from 2020 with no vaccines, the prediction of COVID-19 was performed in a scenario with vaccine administration for Tucumán in 2021. The modeling included the identification of a contagion breaking point between both series with the best correlation. Previously, the lag that served to obtain the smallest error between the expected and observed values was indicated by means of cross correlation. The validation of the model was carried out with real data. In 21 days, 18,640 COVID-19 cases out of 20,400 reported cases were predicted. The maximum peak of COVID-19 was estimated 21 days in advance with the expected intensity.

Background: Multivariate prognostic analysis has been traditionally performed by regression models. However, many algorithms capable of translating an infinity of patterns into probabilities have emerged. The comparative accuracy of artificial intelligence and traditional statistical models has not been established in the medical field., Objective: To test the artificial intelligence as an accurate algorithm for predicting coronary disease in the scenario of acute chest pain and evaluate whether its performance is superior to traditional statistical model., Methods: A consecutive sample of 962 patients admitted with chest pain was analyzed. Two probabilistic models of coronary disease were built using the first two-thirds of patients: a machine learning algorithm and a traditional logistic model. The performance of these two predictive strategies were evaluated in the remaining third of patients. The final logistic regression model had significant variables only, at the 5% significance level., Results: The training sample had an average age of 59 ± 15 years, 58% males, and a 52% prevalence of coronary disease. The logistic model was composed of nine independent predictors. The machine learning algorithm was composed of all candidates for predictors. In the test sample, the area under the ROC curve for prediction of coronary disease was 0.81 (95% CI = 0.77 - 0.86) for the machine learning algorithm, similar to that obtained in logistic model (0.82; 95% CI = 0.77 - 0.87), p = 0.68., Conclusion: The present study suggests that an accurate machine learning prediction tool did not prove to be superior to the statistical model of logistic regression.

Objective: To evaluate the predictive power of different malaria case time-series models in the state of Amapá, Brazil, for the period 1997-2016., Methods: This is an ecological time series study with malaria cases recorded in the state of Amapá. Ten deterministic or stochastic statistical models were used for simulation and testing in 3, 6, and 12 month forecast horizons., Results: The initial test showed that the series is stationary. Deterministic models performed better than stochastic models. The ARIMA model showed absolute errors of less than 2% on the logarithmic scale and relative errors 3.4-5.8 times less than the null model. It was possible to predict future malaria cases 6 and 12 months in advance., Conclusion: The ARIMA model is recommended for predicting future scenarios and for earlier planning in state health services in the Amazon Region.

Objective: to explore the best type of curve or trend model that could explain the epidemiological behavior of the infection by COVID-19 and derive the possible causes that contribute to explain the corresponding model and the health implications that can be inferred., Method: data were collected from the COVID-19 reports of the Department of Epidemiology, Ministry of Health, Chile. Curve adjustment studies were developed with the data in four different models: quadratic, exponential, simple exponential smoothing, and double exponential smoothing. The significance level used was α≤0.05., Results: the curve that best fits the evolution of the accumulated confirmed cases of COVID-19 in Chile is the doubly-smoothed exponential curve., Conclusion: the number of infected patients will continue to increase. Chile needs to remain vigilant and adjust the strategies around the prevention and control measures. The behavior of the population plays a fundamental role. We suggest not relaxing restrictions and further improving epidemiological surveillance. Emergency preparations are needed and more resource elements need to be added to the current health support. This prediction is provisional and depends on keeping all intervening variables constant. Any alteration will modify the prediction.

Objective: to estimate the transmission rate, the epidemiological peak, and the number of deaths by the new coronavirus., Method: a mathematical and epidemiological model of susceptible, infected, and recovered cases was applied to the nine Brazilian capitals with the highest number of cases of the infection. The number of cases for the 80 days following the first case was estimated by solving the differential equations. The results were logarithmized and compared with the actual values to observe the model fit. In all scenarios, it was considered that no preventive measures had been taken., Results: the nine metropolises studied showed an upward curve of confirmed cases of COVID-19. The prediction data point to the peak of the infection between late April and early May. Fortaleza and Manaus had the highest transmission rates (≥2·0 and ≥1·8, respectively). Rio de Janeiro may have the largest number of infected people (692,957) and Florianópolis the smallest (24,750)., Conclusion: the estimates of the transmission rate, epidemiological peak, and number of deaths from coronavirus in Brazilian metropolises presented expressive and important numbers the Brazilian Ministry of Health needs to consider. The results confirm the rapid spread of the virus and its high mortality in the country.

Background and Objectives: The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model., Methods: This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height-to-Thyromental Distance (R-H/TMD), Neck Circumference (NC), Ratio of Neck Circumference-to-Thyromental Distance (R-NC/TMD), Hyomental Distance with head in Neutral Position (HMD-NP) and at Maximal Extension (HMD-HE), Ratio of Hyomental Distance at Maximal head extension-to-hyomental distance in neutral position (R-HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack-Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models., Results: A model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed high prognostic accuracy; x 2 (5)=109.12, p <0.001, AUC=0.86, p <0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R-NC/TMD and HMD-HE) exhibited good prognostic performance; x 2 (2)=63.5, p <0.001, AUC=0.77, p <0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%)., Conclusions: A five-variable model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R-NC/TMD and HMD-HE could be useful in incapable patients. The most accurate single predictor was HE., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: to describe the trend and the spatial distribution of leprosy in the state of Bahia, Brazil, 2001-2015., Methods: this was a mixed ecological study of epidemiological indicators of leprosy; Jointpoint regression was used for the temporal analysis, while spatial scan statistics were used to identify clusters of the disease; the trend was classified as stationary, increasing or decreasing; we calculated the annual percent change (APC) and average annual percent change (AAPC)., Results: there was a reduction in prevalence (AAPC = -5.6; p<0,001), treatment dropout (AAPC = -13.7; p<0.001), and females with leprosy (AAPC = -0.6; p<0.001); the new grade II case coefficient (AAPC = 2.7; p<0.001) and the proportion of multibacillary cases (AAPC = 2,2; p<0.001) showed a growing trend; spatial distribution was heterogeneous and concentrated in three regions in particular (north, west and south of the state), with variation between the indicators., Conclusion: persisting leprosy transmission in the state, late diagnosis and high hidden prevalence is suggested.

The scope of this article was to estimate the prevalence of severe food insecurity (SFI) in Brazilian municipalities in 2013. A logistic regression model was used to predict SFI. To construct the model, the 2013 National Household Sample Survey (PNAD) was used. SFI was measured using the Brazilian Food Insecurity Scale (EBIA). The final model was applied to the 2010 Census, predicting the municipal prevalence. The highest prevalence values were concentrated in the North and Northeast of Brazil, which also showed the highest municipality prevalence disparities. The highest municipal prevalence value of SFI was in the state of Maranhão and the lowest in Rio Grande do Sul. Maranhão was also the State with the largest intrastate disparities in the prevalence of SFI. Spatial analysis showed a higher prevalence of SFI in the North and Northeast regions. Acre had 100% of its municipalities presenting a very high prevalence of SFI. By contrast in the State of São Paulo, 59.1% of the municipalities have a low prevalence of SFI. The prevalence of municipal SFI was higher in Brazil's North and Northeast and there were major disparities in intraregional and intrastate distribution. These prevalence values could assist in improving the targeting of policies to combat food insecurity in Brazil.

Objective: To analyze the time trend and analyze the determinants of stage at diagnosis of cervical cancer in Brazil., Methods: Time trend analysis and cross-sectional study using data from hospital-based cancer registries (2000-2012); multinomial and joinpoint regression statistical models were used., Results: 65.843 cases were analyzed; the median interval between diagnosis and treatment was 59 days; the percentage of advanced staging increased, annual percent change 1.10% (95%CI 0.80;1.50); women with higher education (compared to unlettered) had less odds of late stage diagnosis (OR=0.38; 95%CI 0.31;0.47); among indigenous (OR=2.38; 95%CI 1.06;5.33) and black women (OR=1.16; 95%CI 1.02;1.31), compared to white, and in the North region (OR=2.55; 95%CI 2.26;2.89), compared to the Southeast, the odds was higher; other factors positively related to advanced stage were 'age', 'histology', and marital status'. Conclusion Inequities affect the odds of late stage diagnosis of cervical cancer.

Background: Anaerobic threshold (AT) is recognized as objective and direct measurement that reflects variations in metabolism of skeletal muscles during exercise. Its prognostic value in heart diseases of non-chagasic etiology is well established. However, the assessment of risk of death in Chagas heart disease is relatively well established by Rassi score. But, the added value that AT can bring to Rassi score has not been studied yet., Objectives: To assess whether AT presents additional effect to Rassi score in patients with chronic Chagas' heart disease., Methods: Prospective research of dynamic cohort by review of 150 medical records of patients. Were selected for cohort 45 medical records of patients who underwent cardiopulmonary exercise testing between 1996-1997 and followed until September 2015. Data analysis to detect association between studied variables can be seen using a logistic regression model. The suitability of the models was verified using ROC curves and the coefficient of determination R 2 ., Results: 8 patients (17.78%) died by September 2015, with 7 of them (87.5%) from cardiovascular causes, of which 4 (57.14%) were considered on high risk by Rassi score. With Rassi score as independent variable, and death being the outcome, we obtained an area under the curve (AUC)=0.711, with R 2 =0.214. Instituting AT as independent variable, we found AUC=0.706, with R 2 =0.078. When we define Rassi score and AT as independent variables, it was obtained AUC=0.800 and R 2 =0.263., Conclusion: when AT is included in logistic regression, it increases by 5% the explanation (R 2 ) to the death estimation., (Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

This study aimed to estimate the effects of prognostic factors on breast cancer survival, such as age, staging, and extension of the tumor, using proportional hazards and competing risks models proposed by Cox and Fine-Gray, respectively. This is a retrospective cohort study, based on a population of 524 women, who were diagnosed with breast cancer in the period from 1993 to 1995 and monitored until 2011, residents in the city of Campinas, São Paulo, Brazil. The cutoff points for the variable of age were defined with Cox simple models. In the settings of simple and multiple Fine-Gray models, age was not significant to the presence of competing risks, neither it was in Cox models. For both models, death by breast cancer was the event of interest. The survival functions, estimated by Kaplan-Meier, showed significant differences for deaths by breast cancer and by competing risks. Survival functions by breast cancer did not show significant differences when comparing the age groups, according to log-rank test. Cox and Fine-Gray models identified the same prognostic factors that influenced in breast cancer survival.

It is estimated that approximately 30% of childhood diseases can be attributed to environmental factors and 40% involve children under the age of five years old, representing about 10% of world population. This study aimed to analyze the relationship of climate variables in the prevalence of acute respiratory infection (ARI) in children under two years old, in Rondonopolis-MT, from 1999 to 2014. It was used a cross-sectional study with a quantitative and a descriptive approach with meteorological teaching and research data from the database from the health information system. For statistical analysis, it adjusted the negative binomial model belonging to the class of generalized linear models, adopting a significance level of 5%, based on the statistical platform R. The average number of cases of ARI decreases at approximately by 7.9% per degree centigrade increase above the average air temperature and decrease about 1.65% per 1% increase over the average air relative humidity. Already, the rainfall not associated with these cases. It is the interdisciplinary team refocus practical actions to assist in the control and reduction of ARI significant numbers in primary health care, related climate issues in children.

This study aimed to investigate the association between maternal depressive symptoms and anxiety and interference in the mother/child relationship, using structural equations modeling. Data were used from a prospective cohort study initiated during the prenatal period with 1,140 mothers in São Luís, Maranhão State, Brazil. Data were collected during prenatal care and when the children reached two years of age. Interference in the mother/child relationship was measured with the Postpartum Bonding Questionnaire - PBQ (N = 1,140). In the initial theoretical model, socioeconomic status determined the maternal demographic, psychosocial, and social support factors, which determined the outcome, i.e., the mother/child relationship. Adjustments were performed by structural equations modeling, using Mplus 7.0. The final model showed good fit (RMSEA = 0.047; CFI = 0.984; TLI = 0.981). Depressive symptoms in pregnancy and the postpartum were associated with higher PBQ scores, indicating interference in the mother/child relationship. The greatest effect was from depressive symptoms in pregnancy. Other factors associated with higher PBQ scores were lower social support, unfavorable socioeconomic status, and living without a partner, by indirect association. Anxiety symptoms and maternal age were not associated with the mother/child relationship. The results suggest that identifying and treating depression in pregnancy and postpartum can improve mother/child bonding in childhood.

Background:: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain., Objective:: To develop and validate a multivariate model to predict coronary artery disease (CAD) based on variables assessed at admission to the coronary care unit (CCU) due to acute chest pain., Methods:: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%), while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested., Results:: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC) of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84) in the derivation sample and 0.86 (95%CI = 0.79 - 0.93) in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively). Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002) and validation (p = 0.039) samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001) and validation (p < 0.0015) samples., Conclusion:: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain., Fundamento:: Atualmente, não existe um modelo multivariado validado para predizer a probabilidade de doença coronariana obstrutiva em pacientes com dor torácica aguda., Objetivo:: Desenvolver e validar um modelo multivariado para predizer doença arterial coronariana (DAC) com base em variáveis avaliadas à admissão na unidade coronariana (UC) devido a dor torácica aguda., Métodos:: Foram estudados um total de 470 pacientes, 370 utilizados como amostra de derivação e os subsequentes 100 pacientes como amostra de validação. Como padrão de referência, a angiografia foi necessária para descartar DAC (estenose ≥ 70%), enquanto a angiografia ou um teste não invasivo negativo foi utilizado para confirmar a doença. Foram testadas como preditoras 13 variáveis basais relacionadas à história médica, 14 características de desconforto torácico e oito variáveis relacionadas ao exame físico ou testes laboratoriais., Resultados:: A prevalência de DAC foi de 48%. Por regressão logística, seis variáveis permaneceram como preditoras independentes de DAC: idade, gênero masculino, alívio com nitrato, sinais de insuficiência cardíaca, e eletrocardiograma e troponina positivos. A área sob a curva (area under the curve, AUC) deste modelo final foi de 0,80 (intervalo de confiança de 95% [IC95%] = 0,75 - 0,84) na amostra de derivação e 0,86 (IC95% = 0,79 - 0,93) na amostra de validação. O teste de Hosmer-Lemeshow indicou uma boa calibração em ambas as amostras (p = 0,98 e p = 0,23, respectivamente). Em comparação com o modelo básico contendo eletrocardiograma e troponina, o modelo completo ofereceu um incremento na AUC de 0,07 tanto na amostra de derivação (p = 0,0002) quanto na de validação (p = 0,039). A melhoria na discriminação integrada foi de 0,09 nas amostras de derivação (p < 0,001) e validação (p < 0,0015)., Conclusão:: Um modelo multivariado foi derivado e validado como uma ferramenta acurada para estimar a probabilidade pré-teste de DAC em pacientes com dor torácica aguda.

The present study analyses the spatial pattern of tuberculosis (TB) from 2005 to 2008 by identifying relevant socioeconomic variables for the occurrence of the disease through spatial statistical models. This ecological study was performed in Rio de Janeiro using new cases. The census sector was used as the unit of analysis. Incidence rates were calculated, and the Local Empirical Bayesian method was used. The spatial autocorrelation was verified with Moran's Index and local indicators of spatial association (LISA). Using Spearman's test, variables with significant correlation at 5% were used in the models. In the classic multivariate regression model, the variables that fitted better to the model were proportion of head of family with an income between 1 and 2 minimum wages, proportion of illiterate people, proportion of households with people living alone and mean income of the head of family. These variables were inserted in the Spatial Lag and Spatial Error models, and the results were compared. The former exhibited the best parameters: R2 = 0.3215, Log-Likelihood = -9228, Akaike Information Criterion (AIC) = 18,468 and Schwarz Bayesian Criterion (SBC) = 18,512. The statistical methods were effective in the identification of spatial patterns and in the definition of determinants of the disease providing a view of the heterogeneity in space, allowing actions aimed more at specific populations.

Objective: Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care., Methods: A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima's Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach's alpha and Spearman' coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels., Results: The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists' contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach' alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination., Conclusions: The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care., Objetivo: Analisar a qualidade das variáveis do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica para avaliar a coordenação na atenção básica do cuidado., Métodos: Estudo transversal baseado em dados de 17.202 equipes de atenção básica que participaram do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica em 2012. Baseado na Teoria de Resposta ao Item, o Modelo de Resposta Gradual de Samejima foi utilizado para estimação do escore relacionado ao nível de coordenação. Os coeficientes alfa de Cronbach, Spearman e ponto bisserial foram utilizados para análise da consistência interna e da correlação entre os itens e de itens com o escore total. Foram avaliadas as suposições de unidimensionalidade e de independência local dos itens. Gráficos do tipo nuvem de palavras auxiliaram na interpretação dos níveis de coordenação., Resultados: Os itens do Programa com maior discriminação do nível de coordenação foram: existência de telefone/internet, fluxos institucionais de comunicação e ações de apoio matricial. A frequência de contato de especialistas com a atenção básica e prontuário eletrônico integrado exigiram maior nível de coordenação das equipes. O coeficiente alfa de Cronbach total 0,8018. Os itens fluxos institucional de comunicação e telefone/internet tiveram maior correlação com o escore total. Os escores de coordenação variaram entre -2,67 (mínimo) e 2,83 (máximo). Maior grau de comunicação, troca de informações, apoio matricial, cuidado no território e domicílio tiveram peso relevante nos níveis de coordenação., Conclusões: A capacidade de disponibilizar a informação e a frequência de contato entre os profissionais são elementos importantes para o cuidado abrangente, contínuo e de qualidade.

Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system., Objective: To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation., Method: An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant., Results: There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion., Conclusion: The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.

Studies have evaluated the quality of life (QOL) of many groups; however, such studies in relation to Reference Centers for the Elderly are scarce. This research identified factors associated with a good QOL of people using a Reference Center in the city of Belo Horizonte, MG, Brazil. Transversal study of 257 elderly people who used a Reference Center for the Elderly. The short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) was used to evaluate the QOL of the elderly people. The analysis was rationalized by defining two groups in relation to perceptions of QOL and satisfaction regarding health. Logistic regression analysis was performed to assess the direction and magnitude of the association of each variable with QOL. The results showed that the majority (63.4%) of the elderly people considered that they had a good QOL and that they were satisfied with their health. The environmental domain received the lowest scores (average = 14.4). The factors of advanced age, being from the interior of the state of Minas Gerais, physical activity, diabetes, musculoskeletal diseases, hypertension and depression remained independently associated with QOL and satisfaction with health after the model was adjusted. The data that was obtained can be used to direct care strategies for the most vulnerable elderly people, with particular attention to issues that affect the environment.

The scope of this study is to establish the profile of elderly users of dental services provided by the Brazilian Unified Health System(SUS) and associated factors from the standpoint of equity. It involves an analytical cross-sectional study with hierarchical modeling conducted on the basis of a complex probabilistic sample of groups of the elderly (65-74 years of age) living in a densely populated Brazilian city. Independent variables were included relating to: socio-demographic characteristics, access to information on health, behaviors/health-care system and health outcomes. Descriptive, bivariate and multiple hierarchical analysis was performed. Of the 480 elderly persons included, 138 (31.2%) used dental services from the SUS. Use of these services was greater as per capita income and level of schooling decreased. It was lower among those who had not conducted exams of their own mouths (oral self-examinations) and higher among those individuals who used dental services for non-routine procedures. In addition, people whose relationship had been affected by oral health issues and a negative perception of their appearance used the SUS more frequently. The conclusion drawn is that the use of dental services of the SUS was most prevalent among the elderly living in precarious conditions.