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Introducción: la cardiología es una de las especialidades médicas que cuenta con más revisiones sistemáticas y metanálisis. Estudiar la metodología de las revisiones y anali­zar su heterogeneidad estadística es fundamental para garantizar su validez científica. Objetivo: describir la comparación de medidas de asociación, modelos estadísticos y grado de heterogeneidad en metanálisis de revisiones sistemáticas de intervenciones farmacológicas en cardiología, publicadas entre 2000-2005 y 2011-2016. Metodología: estudio analítico basado en la descripción y comparación de métodos estadísticos de revisiones sistemáticas de intervenciones farmacológicas en cardiología, publicadas en la biblioteca Cochrane. Para las variables cualitativas se estimaron frecuen­cias absolutas y relativas, mientras que para las cuantitativas se determinaron medias y desviaciones estándar, o medianas y rangos intercuartílicos, según su distribución. Para establecer la diferencia de medias se realizó la prueba t de Student y para la diferencia de proporciones el Chi cuadrado. Resultados: se incluyeron 54 revisiones sistemáticas, con un total de 1053 metanálisis, 6 revisiones con 240 metanálisis entre 2000-2005 y 48 revisiones con 813 metanálisis entre 2011-2016. La mayoría de metanálisis utilizaron el tratamiento estándar como grupo de comparación (56.6%), midieron desenlaces cualitativos nominales (86.3%), determinaron riesgos relativos (63.3%) y aplicaron modelos de efectos fijos (57.8%). En 2011-2016 se encontró una media del Índice de Higgins 17.5 menor que en 2000-2005 (p

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Introduction: cardiology is one of the medical specialties with the most systematic reviews and meta-analyses. Studying the methodology of the reviews and analyzing their statistical heterogeneity is essential to guarantee their scientific validity. Objective: to describe the comparison of association measures, statistical models and degree of heterogeneity in meta-analyses of systematic reviews of pharmacological interventions in cardiology, published between 2000-2005 and 2011-2016. Methodology: analytical study based on the description and comparison of statistical methods of systematic reviews of pharmacological interventions in cardiology, published in the Cochrane library. For the qualitative variables, absolute and relative frequencies were estimated, while for the quantitative ones, means and standard deviations, or medians and interquartile ranges, were determined, depending on their distribution. The Student's t test was used to establish the difference in means and the Chi square for the difference in proportions. Results: 54 systematic reviews were included, with a total of 1.053 meta-analyses, 6 reviews with 240 meta-analyses between 2000-2005, and 48 reviews with 813 metaanalyses between 2011-2016. Most meta-analyses used standard treatment as the comparison group (56.6%), measured nominal qualitative outcomes (86.3%), determined relative risks (63.3%), and applied fixed-effect models (57.8%). In the 2011-2016 period, an average of the Higgins Index was found to be 17.5 lower than in the 2000-2005 (p<0.05). Conclusion: there was evidence of a decrease in statistical heterogeneity and an increase in the implementation of random effects models, which accounts for greater rigor when it comes to demonstrating truly significant results. [ABSTRACT FROM AUTHOR]

Abstract Background Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China. Methods A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed and bianzhi (formally established post). Results A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed). Conclusion Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.

This review article explores the seminal contributions of Professor C.R. Rao, one of the most influential statisticians of the 20th century, whose work has profoundly impacted statistical theory and its applications in various fields, particularly in medical statistics. This article discusses the theoretical foundations laid by Rao, including the Rao-Blackwell theorem, Cramer-Rao lower bound, and orthogonal arrays, and examines how these concepts have been applied to enhance medical research, from epidemiological studies to clinical trials. The article highlights the enduring relevance of Rao's work in improving the precision and efficiency of statistical methods used in medical research. The article also outlines his significant achievements and awards, underscoring his global statistical influence., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, L et al.)

Background: Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China.Methods: A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children's education opportunities, working environment, career promotion speed and bianzhi (formally established post).Results: A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed).Conclusion: Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here. [ABSTRACT FROM AUTHOR]

Background:  Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital., Objective: To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen., Methods:  This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management., Results: The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001)., Conclusion:  The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and recognition committee Dr D.Y. Patil Vidyapeeth, Pune issued approval IESC/PGS/2022/177. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shinde et al.)

Objective: To compare academic outcomes between integrated flipped classroom (FC) and solely traditional lecture (TL) teaching approach among 2nd year medical students in Epidemiology and Biostatistics course. Methods: General information and academic achievements including grade point average, scores of the basic statistics course and scores of Epidemiology and Biostatistics course were extracted from the database of the Education Department. The records were excluded if they belonged to repeated or transferred students. The students in 2014 and 2015 academic year represented the TL group and the FC group respectively. The main outcome was the examination score from the two groups which was converted to a comparable scale out of a hundred. Results: Six-hundred twenty-eight records were included in the analysis. Based on independent t-test, the TL group showed higher mean score as compared to the FC group (p-value < 0.01). Further comparison using ANCOVA adjusted for age, gender, hometown location, high school location, grade point average and score of a basic statistics course showed a higher score in the TL group (p-value < 0.01). Conclusion: TL yielded higher examination score than FC from this retrospective study.

ABSTRACT Understanding the cause, severity, and elapsed time for the restoration of the functions of maxillofacial injuries can contribute to the establishment of clinical priorities aiming at effective treatment and further prevention of facial trauma. The objective of this study was to understand the factors associated with the restoration of mastication, ocular, and nasal functions in the face of trauma victims, estimating their recovery time after surgical treatment. We analyzed 114 medical records of patients treated at the Hospital Montenegro, who attended follow-up consultations for up to 180 days. For analysis of the recovery time, we performed survival analysis, followed by COX analysis. We observed that half of the patients recovered their functions within 20 days. The average time for recovery from trauma in the zygomatic-orbital-malar-nasal complex was 11 days, and in the maxillary-mandibular complex, 21 days (HR: 1.5 [0.99 2.3], p = 0.055). Although functional reestablishment has reached high rates after the surgical approach, it is necessary to analyze the failing cases, as well as the economic impacts and the prevention strategies associated with facial trauma, to improve the service to the population.

The use of linear mixed models for nested structure longitudinal data is called hierarchical linear modeling. This modeling takes into account the dependence of existing data within each level and between hierarchical levels. The process of modeling, estimating and analyzing diagnoses was illustrated through data on the weights of mice experimentally infected by Trypanosoma cruzi, divided into different treatment groups, with the purpose of verifying the evolution of their body weight as a result of using different types of biotherapeutics produced from Gallus gallus domesticus (chicken) serum to treat Trypanosoma cruzi. Through the model selection criteria AIC and BIC and the likelihood ratio test, a model was chosen to describe the data correctly. Model diagnoses were then performed by means of residual analysis for both levels and an analysis of influential observations to verify if any observations were signaled as influencing the fixed effects, the components of variance and the adjusted values. After the analysis, it was possible to notice that the observations that were signaled as influential had little impact on the Model chosen initially, so it was maintained, with no differences being evidenced between the treatments with the biotherapeutics tested; only the Time variable and the Random intercept were necessary to describe the weight of the mice.

Objective: To compare academic outcomes between integrated flipped classroom (FC) and solely traditional lecture (TL) teaching approach among 2nd year medical students in Epidemiology and Biostatistics course. Methods: General information and academic achievements including grade point average, scores of the basic statistics course and scores of Epidemiology and Biostatistics course were extracted from the database of the Education Department. The records were excluded if they belonged to repeated or transferred students. The students in 2014 and 2015 academic year represented the TL group and the FC group respectively. The main outcome was the examination score from the two groups which was converted to a comparable scale out of a hundred. Results: Six-hundred twenty-eight records were included in the analysis. Based on independent t-test, the TL group showed higher mean score as compared to the FC group (p-value < 0.01). Further comparison using ANCOVA adjusted for age, gender, hometown location, high school location, grade point average and score of a basic statistics course showed a higher score in the TL group (p-value < 0.01). Conclusion: TL yielded higher examination score than FC from this retrospective study. [ABSTRACT FROM AUTHOR]

Abstract: Background: In this paper, the basic elements related to the selection of participants for a health research are discussed. Sample representativeness, sample frame, types of sampling, as well as the impact that non-respondents may have on results of a study are described. The whole discussion is supported by practical examples to facilitate the reader's understanding. Objective: To introduce readers to issues related to sampling.

Introduction Sensitivity, specificity, and predictive values—the basic statistics behind using and interpreting screening and diagnostic tests—are taught in all medical schools, yet studies have shown that a majority of physicians cannot correctly define and apply these concepts. Previous work has not rigorously examined this disconnect and attempted to address it. Methods We used adult learning theory to design a case-based interactive workshop to review biostatistics and apply them to clinical decision-making using Bayes' theorem. Participants took an anonymous multiple-choice pretest, posttest, and delayed posttest on definitions and application of the concepts, and we compared the scores between the three tests. Several experiences with early iterations provided feedback to improve the workshop but were not included for analysis. Results We conducted the finalized workshop with 54 pediatrics students, residents, and faculty. All learners completed the immediate pre- and posttests, and eight completed the delayed posttest. Average scores rose from 4.5/8 (56%) on the pretest to 6.5/8 (81%) on the posttest and 6.4/8 (80%) on the delayed posttest. Two-tailed t tests showed p < .001 for the difference between the pretest and both posttests, and post hoc power analysis showed a power of 99% to detect the observed differences. There was no significant difference (p = .8) between the posttest and delayed posttest. Discussion Our work demonstrates that an interactive workshop reviewing basic biostatistics and teaching rational diagnostic testing using Bayes' theorem can be effective in connecting theoretical knowledge of biostatistics to evidence-based decision-making in real clinical practice.

AbstractBACKGROUND:Hypothesis tests are statistical tools widely used for assessing whether or not there is an association between two or more variables. These tests provide a probability of the type 1 error (p-value), which is used to accept or reject the null study hypothesis.OBJECTIVE:To provide a practical guide to help researchers carefully select the most appropriate procedure to answer the research question. We discuss the logic of hypothesis testing and present the prerequisites of each procedure based on practical examples.

Introduction Recurrent aphthous stomatitis (RAS) is a common ulcer of idiopathic etiology but is recurrent, causing painful ulcers in the non-keratinized mucosa. The disease is commonly seen in people aged 10-40 years. The etiology of RAS has yet to be well established, but several risk factors that lead to the development of RAS have been proven in the literature. With an unknown etiology, developing a definitive cure and maintaining disease remission remains challenging. An epidemiological survey will shed some light on the disease's prevalence, which could provide insights into disease management. This study aimed to study the prevalence of aphthous stomatitis among the patients visiting the dental outpatient services of a dental college in South India. The objectives were to discover the different subtypes of aphthous stomatitis and the age predominance of the type of ulcer. Materials and methods The data was collected from the case records of Saveetha Dental College and Hospitals, Chennai, India, dated from June 2019 to June 2023. The age and gender of the patients with RAS were recorded. The details collected were systematically arranged in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States) and further analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States) and chi-square tests were run to check for statistical significance. Results A total of 1,44,056 patients visited the Dental OPD during the study period. Of these, 1115 patients had RAS. When the data was analyzed, there was a three-fold increase in the occurrence of RAS during the coronavirus disease 2019 (COVID-19) pandemic, which was statistically significant (p=0.043). The most commonly affected age group was 26-40 years. Among the clinical variants of RAS, it was found that 82.5% of RAS patients had a minor variant of aphthous stomatitis. Conclusion This study shows the prevalence of different types of aphthous stomatitis, wherein we noticed that the minor clinical variant was the most common, followed by the major variant. The lesions were more commonly seen in women. However, the age group most commonly affected was 26-40 years., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Reddy et al.)

Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kim et al.)

We noticed a subjective increase in psychosis admissions within our emergency department (ED) with the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify trends concerning admissions due to psychosis in the ED before and after the beginning of the COVID-19 pandemic. We analyzed 508 psychiatric admissions through the ED from October 2019 to October 2020, of which 367 cases of psychosis were identified. Statistical analysis was performed using T-tests and Pearson's correlation coefficient. T-testing showed mean psychosis admissions during the pandemic (March 2020 to July 2020) to be greater than admissions occurring during the pre-pandemic period (October 2019 to February 2020) (p = 0.04). Pearson's correlation coefficient identified the relationships between COVID-19 admissions and psychosis admissions during this time as positive (r = 0.5) but did not reach statistical significance (p = 0.06). Therefore, within our time frame, we did see a noted increase in psychosis by 22.9% during the pandemic compared to pre-pandemic times. Current research remains conflicted concerning psychiatric ED admissions during COVID-19, with some stating an increase and others finding a decrease. Our data showed a significant statistical increase in the mean number of psychosis cases when comparing pre-pandemic and pandemic admissions. These findings help add pertinent data to understand how psychosis admissions trended before and during the beginning of the COVID-19 pandemic, specifically in South Miami, Florida. It also provides a foundation for future studies by providing data points concerning mental illness within the vulnerable population of patients served in our community., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ross et al.)

Introduction Meningiomas have been described as slow-growing neoplasms with benign behavior derived from the connective tissue surrounding the brain and spinal cord. Meningiomas represent one-third of primary central nervous system (CNS) tumors. The World Health Organization (WHO) initially classified them into three groups based on their histopathological characteristics, recently incorporating molecular patterns. Small cohorts have been reported in Latin America compared to the international literature. Ignoring the epidemiology of meningiomas in this region and considering this limitation, we aim to study the epidemiology of meningiomas in our country, Mexico. Material and methods A historical cohort was carried out on 916 patients diagnosed with intracranial meningiomas from January 2008 to January 2021, considering sociodemographic, topographic, and histopathological characteristics. Results In this study, 69.4% (n=636) of patients were women with a mean overall age of 47.53 (SD=14.85) years; 79.6% (n=729) of the lesions were supratentorial with convexity meningiomas being the most prevalent at 32.6% (n=299). Histopathologically, transitional (45.7%) (n=419), meningothelial (22.1%) (n=202), and fibroblastic (16.7%) (n=153) meningiomas were the most frequent. We found significant differences between men and women in age (p=0.01), infra or supratentorial presentation (p<0.001), location of the lesion (p<0.001), and histopathological characteristics (p<0.001). Conclusions Our results are consistent with what has been reported; however, until now, it appears as the largest series reported in our country and Latin America., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alvaro-Heredia et al.)

FUNDAMENTO: Os estudos disponíveis não analisaram de modo abrangente os vários fatores envolvidos na gênese da hipertensão (HT), especialmente a associação entre pressão arterial, excreção urinária de sódio e disfunção renal. OBJETIVO: Avaliar a prevalência dos fatores de risco para HT em diferentes grupos etários em uma amostra representativa da uma população urbana brasileira. MÉTODOS: A população estudada (1.717 indivíduos adultos) foi avaliada por grupos etários: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As médias das variáveis quantitativas e as variáveis categóricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalência geral ajustada para HT foi de 25,23%. A prevalência aumentou com a idade e era mais alta em indivíduos com baixo nível educacional. Índice de massa corporal e circunferência abdominal aumentados estavam positivamente associados com uma maior prevalência de HT. Havia uma associação positiva significante entre HT e excreção urinaria de sódio. Os indivíduos hipertensos apresentavam maior frequência de disfunção renal, definida como clearance de creatinina FUNDAMENTO: Los estudios existentes no han analizado de modo amplio los varios factores comprendidos en la génesis de la hipertensión (HT), especialmente la asociación entre presión arterial, excreción urinaria de sodio y disfunción renal. OBJETIVO: Evaluar la prevalencia de los factores de riesgo para HT en diferentes grupos etarios, en una muestra representativa de una población urbana brasilera. MÉTODOS: La población estudiada (1.717 individuos adultos) fue evaluada por grupos etarios: 18 a 39 años; 40 a 49; 50 a 59; 60 a 69 y > 70 años. Se compararon los promedios de las variables cuantitativas y las variables categóricas de los grupos normotenso e hipertenso. RESULTADOS: La prevalencia general ajustada para HT fue del 25,23%. La prevalencia aumentó con la edad y era más alta en individuos con bajo nivel educacional. El índice de masa corporal y la circunferencia abdominal aumentados se asociaron positivamente con una mayor prevalencia de HT. Había una asociación positiva significante entre HT y excreción urinaria de sodio. Los individuos hipertensos presentaban mayor frecuencia de disfunción renal, definida como clearance de creatinina < 60 ml/min/m². La prevalencia de diabetes mellitus en la población general era del 5,6% y 14,5% en los individuos hipertensos. La hipertensión era una condición conocida por el 74,4% de los individuos hipertensos. Entre los individuos hipertensos tratados, el 52,4% tenían una hipertensión controlada y sólo el 34,3% de los pacientes hipertensos en general (tratados o no) tenían la presión arterial controlada. CONCLUSIÓN: Este estudio de base poblacional es especial, debido al hecho de agregar diferentes factores demográficos, epidemiológicos y de riesgo comprendidos en la génesis de la hipertensión en la evaluación de una única muestra con un cálculo poblacional que puede ser extrapolado a otras poblaciones hipertensas.BACKGROUND: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE: To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS: The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS: The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance

OBJETIVOS: Determinar a prevalência de depressão maior em uma população de sujeitos acima de 80 anos residentes na comunidade, comparar os padrões de sono e a função cognitiva entre controles normais e sujeitos com depressão maior e estimar a freqüência de outros transtornos psiquiátricos entre controles e sujeitos deprimidos. MÉTODOS: De uma população de 219 habitantes com mais de 80 anos, residentes em um município semi-rural no sul do Brasil (município de Veranópolis, RS), selecionou-se uma amostra randômica e representativa de 77 sujeitos (35%). Desse grupo, 5 sujeitos que apresentavam critérios de DSM-IV para depressão maior foram comparados com 50 controles sem diagnóstico de demência, delirium ou qualquer transtorno do humor. Os padrões de sono foram avaliados pelo Índice de Pittsburgh de Qualidade do Sono e por um diário do ciclo sono/vigília completado ao longo de duas semanas. Para a avaliação cognitiva, foram usados 5 testes neuropsicológicos: teste de lembranças seletivas de Buschke-Fuld; teste lista de palavras da bateria do CERAD; teste de fluência verbal; e 2 subtestes da bateria de memória de Wechsler. RESULTADOS: A prevalência de depressão maior foi de 7,5%. Sujeitos com esse diagnóstico, quando comparados a sujeitos do grupo-controle, apresentavam mais freqüentemente comorbidade com transtorno de ansiedade generalizada, usavam mais benzodiazepínicos e tinham uma pior qualidade de vida pela escala "Short-form 36". Os idosos deprimidos, quando comparados aos controles, tinham os mesmos padrões de sono e apresentavam o mesmo desempenho nos testes neuropsicológicos. CONCLUSÃO: Os resultados corroboram o conceito de que episódios depressivos são freqüentes entre idosos com mais de 80 anos, causando impacto sobre a qualidade de vida associada à saúde e cursando comorbidade freqüente com transtorno de ansiedade generalizada. Entre os idosos octogenários residentes na comunidade, a depressão maior não aparecia clinicamente sob a forma de "pseudodemência" depressiva e nem tinha impacto sobre os padrões de sono.OBJECTIVES: To determine the prevalence of major depression in a community-dwelling population aged 80 years or more. The secondary objective was to compare this population's sleep patterns, cognitive function and frequency of other psychiatric disorders with a normal control group and other subjects with major depression. METHODS: A representative sample of 77 subjects (35%) aged 80 years or more was randomly selected from the rural southern county of Veranopolis, Brazil. Of them, 5 subjects met the DSM-IV criteria for major depression disorder and 50 control subjects (without dementia, delirium or any mood disorder) were compared. Sleep patterns were assessed using the Pittsburgh Sleep Quality Index and a 2-week-sleep/wake diary. Five neuropsychological tests (the Buschke-Fuld Selective Reminding Test, the CERAD battery word list, the Verbal Fluency Test, and two sub-tests of the Wechsler memory scale) were used for cognitive evaluation. RESULTS: The point prevalence rate for major depression was 7.5%. When compared to the control group, subjects with major depression had a higher frequency of generalized anxiety disorder as a comorbid condition, used more benzodiazepines and had a worse life quality according to the Short-form 36 scale. Depressed elderly people showed the same sleep patterns, and performed in the same manner in the cognitive tests as controls. CONCLUSION: The results corroborate the hypothesis that major depressive disorder is frequently found among the elderly population aged 80 or more. This disorder causes impact on life quality concerning health, and often occurs in association with generalized anxiety disorder. Among elderly aged 80 or more living in this community, major depression neither manifested as a form of depressive pseudo-dementia, nor did it have any impact on sleep patterns.

The aim of this review was to evaluate the risk of COVID-19 cytokine release syndrome (CRS) with HIV infection and meta-regress for indicator covariates. Electronic databases, including Google Scholar, Cochrane Library, Web of Sciences (WOS), EMBASE, Medline/PubMed, COVID-19 Research Database, and Scopus, were systematically searched till February 30, 2022. All human studies were included, irrespective of publication date or region. Eleven studies, with a total of 2,005,274 detailing cytokine release syndrome defined by specific parameters, were included. To pool the estimate, a random-effects model with risk ratio (RR) as the effect measure was used. Moreover, publication bias and sensitivity analysis were evaluated followed by meta-regression analysis to account for any possible covariates. This systematic review, meta-analysis, and meta-regression trial was registered (CRD42021264761) on the PROSPERO register. HIV infection showed an increased risk for COVID-19 cytokine release syndrome (RR= 1.48, 95% CI (1.16, 1.88) (P=0.002)) with substantial heterogeneity (I 2 > 80%) and a 4.6% cumulative incidence. The true effects size in 95% of all the comparable populations (prediction interval) fell between 0.67 to 3.29. HIV infection further showed an increased risk for intensive care unit (ICU) admission ((P<0.0001) (I² = 0%)] and mechanical ventilation (MV) ((P=0.04) (I² = 0%)) as the key indicators of cytokine release syndrome. Meta-regression analysis demonstrated that COVID-19 cytokine release syndrome was influenced by the year a study was published (R² = 0.55) and the region from where the study was conducted (R² = 0.11). On meta-regression analysis, the combined impact of all covariates in the model explained at least some of the variance in effect size (Q = 16.21, df = 6, P= 0.0127), and the proportion of variance explained by covariates on comparing the model with and without the covariates was 73 % and highly significant (Tau² = 0.1100, Tau = 0.3317, I² = 86.5%, Q = .99, df = 10, P<0.0001) (R² = 0.73). Our updated meta-analysis indicated that HIV infection was significantly associated with an increased risk for COVID-19 cytokine release syndrome, which, in addition, might be moderated by the year a study was published and the region in which the study was conducted. Further, the risk for intensive care unit (ICU) admission and mechanical ventilation (MV) were identified as the key indicators of cytokine release syndrome. We believe the updated data anchoring cytokine release syndrome will contribute to more substantiation of the findings reported by similar earlier studies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Muthuka et al.)

Objectives To explore the association between depression, poor mental health status, and asthma control patterns among US adults using a latent class analysis (LCA) approach. Methods We used data from 10,337 adults aged 18 years and above from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey. Data-reductive LCA was used to derive asthma control patterns in the population using class variables indicative of asthma control. Besides univariate analysis, adjusted and unadjusted logistic regression models were used to examine the association of depression and poor mental health on the derived asthma control patterns.  Results About 27.8% of adults aged <55 reported depression, while 27.3% aged ≥55 years were depressed. The latent class prevalence of asthma control patterns was 42.8%, 31.1%, and 26.1%, corresponding to good, fair, and poor asthma control patterns, respectively. In adults aged <55 years, odds of depression (OR=1.52, 95% CI=1.27-1.82) and poor mental health (OR=1.58, 95% CI=1.27-1.96) were higher in the poor asthma control group compared to the good asthma control group. Odds for depression (OR=1.28, 95% CI=1.06-1.53) were also higher in the moderate asthma control group compared to the good asthma control group. Among those aged ≥55 years, depression odds (OR=1.57, 95% CI=1.31-1.87) were higher in only the poor asthma control group. Conclusions These findings may have public health implications. Detecting, screening, and treating depression and mental health disorders may help improve asthma control in people with asthma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ogbu et al.)

Objective. Apply and assess a Bayesian approach to projecting cancer mortality rates by fitting age-period-cohort (APC) models. Methods. The Bayesian estimation method was applied to bladder cancer mortality data in Argentina. A second-order auto regressive model was adopted for a priori specification of APC model coefficients. The estimates obtained were compared with all available information and excluding age groups with low mortality, to assess behavior of the approach in light of scattered data. Mortality was projected for two successive periods following the ones observed. Results. Robustness of the method was verified, which avoids excluding age groups with null or low mortality. Observed rates all fall within the credibility bands and confirm the model's goodness of fit. An overall downward trend in bladder cancer mortality was observed. Estimates and projections of these rates are more precise in age groups that have greater incidence of mortality. Conclusions. The Bayesian formulation used herein makes it possible to reduce random variation between adjacent estimates by specifying that the effects of each scale depend on the immediately preceding ones. It was demonstrated that the approach has the capacity to handle low frequencies and obtain reliable mortality estimates, as well as precise projections, without the need for making additional assumptions, as happens in classical APC model fitting. [ABSTRACT FROM AUTHOR]

Background An epidemiological survey was conducted among the geriatric population to determine the status and need for dental prosthetics and their influence on oral health-related quality of life (OHRQoL). Methodology The study population consisted of 270 patients aged 60 or older. All pertinent demographic information, clinical data on prosthesis status and need, and the Oral Health Impact Profile (OHIP)-14 questions to assess OHRQoL were collected using a pretested structured questionnaire written in the patient's native tongue. In addition, a type 3 oral examination was performed on a sample of the geriatric population. Results The OHRQoL was found to be unaffected by the prosthetic status. However, there was a strong correlation between the elderly study population's OHRQoL and the need for a prosthetic. Of each variable in OHRQoL, physical pain, discomfort when eating, and loss of taste were the most affected in this population. Conclusions The prosthetic needs of the study population must be given high priority as there are many unmet needs. The concerned health departments need to seriously consider increasing facilities with an affordable system. There is a lack of appreciation for OHRQoL. However, given that a satisfactory clinical assessment of the mouth does not always indicate good oral health status, the justification for evaluating dental care with respect to oral well-being is compelling., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Prakash et al.)

Objective. Assess use of the intrinsic estimator (IE) technique in epidemiology. Methods. The IE approach was applied to the analysis of breast cancer data in Argentina in order to observe the trends associated with "age, period, and cohort" (APC). This method involves the use of a principal components regression to obtain a single set of estimated trends. The results were compared to the findings obtained with the conventional method, which consists of adjusting a generalized linear model that includes the traditional constraints of the statistical model as well as an additional constraint (CGLM). Results. Both methods yielded compatible results in the trends associated with APC. However, they differed in the confidence intervals, with IE yielding greater efficiency. The curve associated with age showed the expected pattern of change across the life course: the greater the age, the greater the risk. With regard to cohorts, a de- crease in the effects associated with the most recent cohorts was evident, whereas there was very little variation in the estimated effects for the period. Conclusions. A comparison of the results obtained with the IE method and the CGLM method revealed the reach of the generic solution provided by the IE to the problem of estimates in an APC model. The IE method is based on conversion of the data observed using a weighting matrix that is simple to apply and provides estimates with desirable statistical properties. [ABSTRACT FROM AUTHOR]

Background and Aim: Experience at the national and international levels shows that internal evaluation, especially at the level of academic departments, can play a critical role in warranting having a university with high standards. The objectives of the present research project were to determine (a). the quality of the structural elements of the Epidemiology and Biostatistics Department (EBD) School of Public Health, Tehran University of Medical Sciences, and (b). The strengths, weaknesses, opportunities and threats, on the basis of which action could be taken to improve the quality of activities in the Department. Materials and Methods: The study was conducted with the collaboration of the head and faculty members, all of the students (residents, Ph.D. and M.S. students), and the graduates, of the EBD. Nine variables were studied, namely, 1). Aims and objectives; 2). Organizational and management structure; 3). Faculty members; 4). Students; 5). Teaching and learning process; 6). Courses and curricula; 7). Graduates; 8). Research and educational facilities and equipment; and 9). Research activities of the faculty members. First the initial weight of the 9 variables were determined by opinion poll carried out among all the faculty members of EBD. Then unrelated data were identified through proper tests and omitted and the final weights extracted. The tools used to collect the data included interview, observation, and 7 self-prepared questionnaires and 2 check lists. Results: The mean score for the 9 factors studied was 59.8%, the range being between 37.0% (for objectives and mission) and 72.0% (for graduates). Conclusion: The graduate domain is one of the key areas in internal evaluation of the Department of Epidemiology and Biostatistics. On the other hand, the lower score for objective and aims domain implicates the need for future intervention in this domain. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence of visual impairment and eye abnormalities in Oklahoma Indians. Methods The cross-sectional study included 1019 Oklahoma Indians, aged 48 to 82 years; 60.2% were women. All participants gave a personal interview, and all underwent an eye examination, including the determination of best-corrected visual acuity and an ophthalmoscopic examination. In addition, two 45° fundus photographs were taken of each eye, and these photographs were graded by the Fundus Photography Reading Center at the University of Wisconsin, Madison. Results Among the 1019 participants, 77.4% had a visual acuity of 20/20 or better, 19.5% and 2.5% had visual acuities of between 20/25 and 20/40 and between 20/50 and 20/190, respectively; and 0.6% were legally blind, all in the better eye. Cataract was the most frequent contributing cause and age-related macular degeneration the second most frequent contributing cause of visual impairment. The overall prevalence proportions of age-related macular degeneration, cataract, diabetic retinopathy, and definite glaucoma were 33.6%, 39.6%, 20.1%, and 5.6%, respectively. Most of the other eye abnormalities were rare in the study participants, except for pinguecula (42.4%) and dermatochalasis (30.1%). Conclusions Oklahoma Indians have a higher prevalence of visual impairment, age-related macular degeneration, and diabetic retinopathy than other ethnic groups. The implementation of adequate treatment and prevention programs for eye diseases is indicated. [ABSTRACT FROM AUTHOR]

Objective To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma. Methods We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001). Results Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001). Conclusions No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity. [ABSTRACT FROM AUTHOR]

Objective To develop a simplified clinical scale defining risk categories for development of advanced age-related macular degeneration (AMD). Methods Following development of a detailed scale for individual eyes based on gradings of fundus photographs in the Age-Related Eye Disease Study, rates of progression to advanced AMD were assessed in cross-tabulations of presence or absence in each eye of 2 easily identified retinal abnormalities, drusen and pigment abnormalities. Large drusen and any pigment changes were particularly predictive of developing advanced AMD. Results The scoring system developed for patients assigns to each eye 1 risk factor for the presence of 1 or more large (≥125 μm, width of a large vein at disc margin) drusen and 1 risk factor for the presence of any pigment abnormality. Risk factors are summed across both eyes, yielding a 5-step scale (0-4) on which the approximate 5-year risk of developing advanced AMD in at least one eye increases in this easily remembered sequence: 0 factors, 0.5%; 1 factor, 3%; 2 factors, 12%; 3 factors, 25%; and 4 factors, 50%. For persons with no large drusen, presence of intermediate drusen in both eyes is counted as 1 risk factor. Conclusion This simplified scale provides convenient risk categories for development of advanced AMD that can be determined by clinical examination or by less demanding photographic procedures than used in the Age-Related Eye Disease Study. [ABSTRACT FROM AUTHOR]

Objective To report the prevalence of age-related macular degeneration (AMD) in a population-based sample of Hispanic individuals aged 50 years and older. Methods Proyecto VER (Vision and Eye Research) is a population-based study of blindness and visual impairment of Hispanic people in Arizona. Participants underwent complete ophthalmic evaluation, including stereoscopic fundus photography of fields 1, 2, and 4. All photographs for participants aged 50 years and older were graded using the Wisconsin Age-Related Maculopathy Grading system. The following signs were graded: drusen size, drusen type, and the area covered by drusen; pigmentary abnormalities; geographic atrophy; and exudative AMD. Results Sixty-seven percent (3178) of the original 4774 participants were 50 years of age or older. Of those, 92% (2928) had fundus photographs in at least 1 eye, and 95% (2780) of the photographs were of sufficient quality to grade early and late AMD. Outcome Measures The overall prevalence of late AMD was 0.5%. The prevalence increased from 0.1% in the 50- to 59-year age group to 4.3% in the group aged 80 years and older. Likewise, early AMD was strongly associated with age with a prevalence of 20% in the 50- to 59-year age group, increasing to 54% in the group aged 80 years and older. The prevalence of early AMD in Hispanic people was significantly higher than the reported prevalence in the white population. However, the prevalence of late AMD was lower than the estimates for the white population of the United States. Conclusions Although early macular changes were very common among Hispanic people, the prevalence of late AMD was infrequent. Further work is necessary to understand the underlying reasons for the different patterns of presentation of early and late signs of AMD among racial/ethnic groups and to characterize early AMD based on predictive value for severe disease in different populations. [ABSTRACT FROM AUTHOR]

Objective To compare the uptake of cataract surgery in nursing homes in which assistance was provided in obtaining services with that in control homes. Methods The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) project is a randomized clinical trial studying the effect of a comprehensive vision restoration-rehabilitation program, including the provision of cataract surgery services when needed. Twenty-eight nursing homes in the Eastern Shore area of Maryland and Delaware were matched in pairs by size and payment type. Nursing homes within each pair were randomized to usual care or targeted intervention. Persons with cataract causing visual acuity in the better eye to be worse than 20/40 were informed of the possible benefit of cataract surgery. For those in intervention homes, additional support was provided in obtaining cataract surgery. Results Of residents with vision-impairing cataract in intervention homes, 31% underwent cataract surgery vs 2% in usual-care facilities. Residents with cataract compared with all residents without visual impairment, regardless of nursing home assignment, tended to be older (mean age, 86.7 vs 82.1 years; P<.001), were more likely to be black (age-adjusted P<.001), had lower Mini-Mental State Examination scores (mean, 11.7 vs 16.2; age-adjusted P<.001), and longer length of stay (mean, 42.3 vs 24.4 months; P<.001). Furthermore, cataract was associated with significant visual impairment and with functional limitations, with 20% of those recommended for surgery having a visual acuity of 20/100 or worse in the better-seeing eye. Conclusions Screening for and identifying cataracts as a cause of vision loss rarely results in uptake of cataract surgery services in nursing homes. The addition of a support system to facilitate the process of scheduling surgery and getting to and from the hospital dramatically increases uptake rates. [ABSTRACT FROM AUTHOR]

Objective To assess the association between mortality and cause-specific visual impairment in older people. Methods Visual acuity and causes of visual impairment were collected in 13 569 participants 75 years and older participating in a randomized trial of health screening. Participants were followed up for mortality for a median of 6.1 years. Results Compared with those with 6/6 (or 20/20 Snellen) or better visual acuity, the age- and sex-adjusted rate ratio for visually impaired people (binocular visual acuity <6/18 or <20/60 Snellen) was 1.60 (95% confidence interval, 1.47-1.74), which was markedly attenuated (rate ratio, 1.17; 95% confidence interval, 1.07-1.27) after adjustment for confounding factors. People whose visual impairment was due to cataract or age-related macular degeneration had excess risks of all-cause and cardiovascular mortality, which disappeared after adjustment. People with refractive error remained at small risk, despite adjustment, probably owing to residual confounding from factors associated with minimal use of eye services rather than underlying eye disease. There were no associations with cancer mortality. Conclusion Associations reported for visual impairment and mortality or for specific causes of visual impairment reflect confounding by comorbidities, risk factors, and other factors related to susceptibility to death rather than an independent biological association of vision problems or specific eye diseases. [ABSTRACT FROM AUTHOR]

Objective To evaluate the development of refraction, expressed as spherical equivalents, in prematurely born children during the first 10 years of life. Methods Retinoscopy in cycloplegia was performed at 6 months, 2.5 years, and 10 years of age in 198 prematurely born children from a previous population-based study on the incidence of retinopathy of prematurity. Spherical equivalents were calculated. Myopia was defined as a spherical equivalent of less than 0 diopters (D), clinically significant myopia at 10 years of age as -1 D or less, and moderate or high myopia as less than -3D. Hypermetropia greater than +3 D was regarded as significant. Results There were no significant differences during the refractive development between the various subgroups of retinopathy of prematurity. Cryotreated eyes had a wider distribution of refractive errors. A multiple regression analysis revealed that the spherical equivalents at 2.5 years of age predicted clinically significant myopia (≤-1 D) at 10 years of age. Conclusions Retinoscopies at 6 months, 2.5 years, and 10 years of age show a similar course of spherical equivalent refractive development regardless of the stage of retinopathy of prematurity. Refraction at 6 months of age is an unreliable predictor, but the refraction at 2.5 years of age seems to be a better tool for identifying refractive errors that will remain at 10 years of age. [ABSTRACT FROM AUTHOR]

Objective To investigate the magnitude of the genetic risk of nonsyndromic rhegmatogenous retinal detachments (RRDs) in a familial aggregation study. Design Two hundred three consecutive patients with RRD and 461 controls without RRD were ascertained at the Department of Ophthalmology of the University Medical Centre Nijmegen in Nijmegen, the Netherlands. Data on family composition, history of RRD, and presence of other risk factors in siblings and offspring were collected by means of a questionnaire. Diagnosis of RRD was confirmed by evaluation of medical records. Results One hundred eighty-one patients (89.2% of those eligible) and 408 controls (88.5% of invited controls) with 1090 and 2345 relatives, respectively, were included in the analysis. Thirteen familial RRDs (1.2%) were diagnosed in 10 case probands and 9 RRDs (0.4%) in 8 control probands. Siblings and offspring of cases had a higher incidence of RRD independent of age, sex, and myopia. The cumulative lifetime risk of RRD was 7.7% for relatives of cases and 3.0% for relatives of controls, yielding a risk ratio of 2.6 (95% confidence interval, 1.1-6.2). Conclusions Familial occurrence of RRD is a risk factor for RRD. Genetic factors apart from myopia may explain the increased familial risk. [ABSTRACT FROM AUTHOR]