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UNIVERSIDADE FEDERAL DO RIO DE JANEIRO INSTITUTO DE ESTUDOS DE SAÚDE COLETIVA DEPARTAMENTO DE MEDICINA PREVENTIVA
FACULDADE DE MEDICINA
PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA DISCIPLINA: INTRODUÇÃO À EPIDEMIOLOGIA
Exercícios – Delineamentos de estudos 1. Leia os resumos a seguir e responda a) Qual o objetivo/hipótese do estudo? b) Qual a população de estudo? c) Qual(is) o(s) fator(es) em estudo e qual (is) o(s) desfecho(s)? d) Qual o delineamento utilizado? Justifique. Resumo 1 (ano publicação – 2003) Objetivo: O leite materno, por suas características nutricionais e imunológicas, protege a criança contra a diarréia. Para avaliar a proteção da amamentação contra a diarréia em menores de um ano, foi realizado um estudo em Feira de Santana, Bahia, no ano de 2001. Métodos: Foram aplicados questionários às mães, por 104 universitários, no dia nacional de vacinação, nas 44 (71,0%) unidades selecionadas por estratificação simples e avaliadas 2.319 crianças, representando 24,3% da população estimada. Foi calculada a razão de prevalência e considerado como significante p< 0,05 e intervalo de 95% de confiança. Resultados: A ocorrência de diarréia foi elevada (11,6%), com maior freqüência após o sexto mês (63,3%). As crianças menores que seis meses que não mamavam apresentaram uma chance de 64,0% (IC95%: 1,07–2,51) a mais para a diarréia (p< 0,02) do que aquelas amamentadas. Quando comparadas com as que mamavam exclusivamente, houve um aumento dessa chance para 82,0% (IC95%: 1,11–3,01) entre as não amamentadas. Conclusões: Foi evidente a proteção da amamentação e do aleitamento exclusivo contra a diarréia nos menores de seis meses. Aleitamento materno, diarréia, criança. Resumo 2 (ano publicação – 2006) Background Frequent germ line cells mutations were previously demonstrated to be associated with aging. This suggests a higher incidence of childhood cancer among children of older parents. A population-based study of parental ages and other prenatal risk factors for five main childhood cancers was performed with the use of a linkage between several national-based registries. Methods In total, about 4.3 million children with their parents, born between 1961 and 2000, were included in the study. Multivariate Poisson regression was used to obtain the incidence rate ratios (IRR) and 95% confidence interval (CI). Children 5 years of age and children 5–14 years of age were analysed independently. Results There was no significant result for children 5–14 years of age. For children 5 years of age, maternal age were associated with elevated risk of retinoblastoma (oldest age group’s IRR 5 2.39, 95%CI 5 1.17–4.85) and leukaemia (oldest age group’s IRR 5 1.44, 95%CI 5 1.01–2.05). Paternal age was significantly associated with leukaemia (oldest age group’s IRR 5 1.31, 95%CI 5 1.04–1.66). For central nervous system cancer, the effect of paternal age was found to be significant (oldest age group’s IRR 5 1.69, 95%CI 5 1.21–2.35) when maternal age was included in the analysis. Conclusion Our findings indicate that advanced parental age might be associated with na increased risk of early childhood cancers.
Resumo 3 (ano publicação – 2011)
Fruit and vegetable consumption is an important component of a healthful diet, yet fruits and vegetables are underconsumed, especially among low-income groups with high prevalence rates of obesity. This study used data from the US Department of Agriculture Economic Research Service Food Environment Atlas to examine county-level associations among obesity prevalence and per capita farmers' markets, grocery stores/supermarkets, and supercenters, adjusted for natural amenities, percent black, percent Hispanic, median age, and median household income, stratified by county metropolitan status. In models that included all three of the food venues, supercenters and grocery stores per capita were inversely associated with obesity in the combined (metro and nonmetro) and metro counties. Farmers' markets were not significant in the model for combined (metro and nonmetro) or for metro counties alone, but were significantly inversely related to obesity rates in the model for nonmetro counties. Density of food venues was inversely associated with county-level obesity prevalence. Thus, future research should examine similar associations at the individual-level.
Resumo 4 (ano publicação – 2006) Constitutional factors and sun exposure are associated with skin cancer risk. However, these relations are complex and differ according to skin cancer type. Methods: We examined the associations of constitutional risk factors and sun exposure with the risks of three types of skin cancer simultaneously and evaluated the interaction between constitutional susceptibility and sun exposure in a study nested within the Nurses’ Health Study [200 melanoma, 275 squamous cell carcinoma (SCC), and 283 basal cell carcinoma (BCC) cases, and 804 controls]. Information regarding skin cancer risk factors was obtained from the retrospective supplementary questionnaire. Results Constitutional susceptibility was an independent risk factor for all three types of skin cancer. Sunlamp usage or tanning salon attendance was a risk factor for melanoma after adjusting for potential confounding variables (OR for ever vs never usage, 2.06, 95% CI 1.30–3.26). Higher sun exposure while wearing a bathing suit was an independent risk factor for all three types of skin cancer. We observed a significant interaction between constitutional susceptibility and sun exposure while wearing a bathing suit on melanoma risk (P, interaction, 0.03); women with the highest susceptibility and highest exposure had an OR of 8.37 (95% CI 3.07–22.84). This interaction was weaker and non-significant for SCC and BCC. Conclusions These data largely confirm past studies on risk factors for skin cancer but provide evidence of difference on the strength of these risk factors for melanoma compared with SCC and BCC. Resumo 5 ( ano de publicação – 2005) Neste estudo o objetivo foi analisar o cumprimento de metas da OMS para a cárie dentária no ano 2000 em Minas Gerais, identificando fatores associados à variação no índice de cárie (CPO-D médio) e ocorrência de CPO-D ≤ 3 em crianças de 12 anos, e no percentual de crianças livres de cáries aos cinco anos de idade. Foram utilizados dados secundários de diferentes fontes. As técnicas de regressão linear e regressão logística múltiplas foram aplicadas nas análises das variáveis dependentes numéricas e dicotômica. Indicadores sócio-econômicos e da oferta/utilização de serviços odontológicos foram empregados como variáveis explicativas potenciais. As metas expressas pelo CPO-D ≤ 3 aos 12 anos e pelo percentual mínimo de 50% de crianças livres de cárie aos cinco anos foram atingidas por 37% e 9% dos municípios, respectivamente. De modo geral, as variáveis dependentes mostraram-se associadas ao nível sócio-econômico, não se identificando associações com as variáveis relativas à atenção odontológica. Os resultados não devem ser generalizados, mas indicam iniqüidades na saúde bucal e o papel desempenhado por fatores sócio-econômicos e a fluoretação da água.
Resumo 6 ( ano de publicação – 2005) BACKGROUND: Peginterferon-ribavirin therapy is the current standard of care for chronic infection with hepatitis C virus (HCV). The rate of sustained virologic response has been below 50% in cases of HCV genotype 1 infection. Boceprevir, a potent oral HCV-protease inhibitor, has been evaluated as an additional treatment in phase 1 and phase 2 studies. METHODS: We conducted a double-blind study in which previously untreated adults with HCV genotype 1 infection were randomly assigned to one of three groups. In all three groups, peginterferon alfa-2b and ribavirin were administered for 4 weeks (the lead-in period). Subsequently, group 1 (the control group) received placebo plus peginterferon-ribavirin for 44 weeks; group 2 received boceprevir plus peginterferon-ribavirin for 24 weeks, and those with a detectable HCV RNA level between weeks 8 and 24 received placebo plus peginterferon-ribavirin for an additional 20 weeks; and group 3 received boceprevir plus peginterferon-ribavirin for 44 weeks. Nonblack patients and black patients were enrolled and analyzed separately. RESULTS: A total of 938 nonblack and 159 black patients were treated. In the nonblack cohort, a sustained virologic response was achieved in 125 of the 311 patients (40%) in group 1, in 211 of the 316 patients (67%) in group 2 (P<0.001), and in 213 of the 311 patients (68%) in group 3 (P<0.001). In the black cohort, a sustained virologic response was achieved in 12 of the 52 patients (23%) in group 1, in 22 of the 52 patients (42%) in group 2 (P=0.04), and in 29 of the 55 patients (53%) in group 3 (P=0.004). In group 2, a total of 44% of patients received peginterferon-ribavirin for 28 weeks. Anemia led to dose reductions in 13% of controls and 21% of boceprevir recipients, with discontinuations in 1% and 2%, respectively. CONCLUSIONS: The addition of boceprevir to standard therapy with peginterferon-ribavirin, as compared with standard therapy alone, significantly increased the rates of sustained virologic response in previously untreated adults with chronic HCV genotype 1 infection. The rates were similar with 24 weeks and 44 weeks of boceprevir. (Funded by Schering-Plough [now Merck]; SPRINT-2 ClinicalTrials.gov number, NCT00705432.). Resumo 7 (ano publicação – 2007) Objective: To examine long-term risk of subsequent fracture following initial osteoporotic fracture in men and women. Design, Setting, and Participants Prospective cohort study (Dubbo Osteoporosis Epidemiology Study) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005. Main Outcome Measure Incidence of first (initial) fracture and incidence of subsequent fracture according to sex, age group, and time since first fracture. Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture. Results There were 905 women and 337 men with an initial fracture, of whom 253 women and 71 men experienced a subsequent fracture. Relative risk (RR) of subsequent fracture in women was 1.95 (95% confidence interval [CI], 1.70-2.25) and in men was 3.47 (95% CI, 2.68-4.48). As a result, absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older. Thus, women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years (95% CI, 26-48/1000) and 37/1000 personyears (95% CI, 23-59/1000), respectively. The increase in absolute fracture risk remained for up to 10 years, by which time 40% to 60% of surviving women and men experienced a subsequent fracture. All fracture locations apart from rib (men) and ankle (women) resulted in increased subsequent fracture risk, with highest RRs following hip (RR,9.97; 95% CI, 1.38-71.98) and clinical vertebral (RR,15.12; 95% CI, 6.06-37.69) fractures in younger men. In multivariate analyses, femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men. Conclusion After an initial low-trauma fracture, absolute risk of subsequent fracture was similar for men and women. This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years.