INTRODUÇÃO: A doença diarréica aguda é ainda importante causa de morbidade no mundo. Sua elevada incidência e a aceitação de sua ocorrência como fato "normal" impõem desafios para seu registro e implantação de seus sistemas de vigilância. OBJETIVOS: Conhecer as características epidemiológicas da diarréia aguda e avaliar a capacidade de detecção de surtos pelo Programa de Monitorização da Doença Diarréica Aguda, no município de Avaré. MÉTODOS: De 27 de fevereiro a 16 de julho 2005, realizou-se estudo prospectivo da diarréia em unidade sentinela do programa. Os surtos identificados foram investigados por estudos descritivos e analíticos. Amostras de fezes foram coletadas para os casos envolvidos nos surtos. A avaliação dos propósitos do programa embasou-se em indicadores de utilidade, sensibilidade e oportunidade. RESULTADOS: Foram identificados 408 casos (Coeficiente de Incidência = 4,7/1000 habitantes); idade mediana de 7 anos (variação de 1 mês a 89 anos) e 54% do sexo masculino. Dos quatro surtos de diarréia confirmados, dois ocorreram em uma creche e em um orfanato, devido à Giárdia lamblia e Cryptosporidum spp.; um intradomiciliar de origem alimentar, sem identificação do agente, e uma epidemia na comunidade associada ao rotavírus. Dos casos atendidos...

Este artigo tem como objetivo discutir conceitos epidemiológicos essenciais e sua aplicação na investigação dos determinantes de doenças que acometem as crianças. A estruturação de uma pesquisa inicia, freqüentemente, pela formulação de uma hipótese e segue com a escolha de um delineamento, em que são definidos os fatores em estudo, o desfecho, a população a ser investigada e as estratégias empregadas na sua execução. Nos estudos observacionais (transversais, de coorte, de casos e controles), o investigador quantifica metodicamente os fenômenos a partir da observação, enquanto que nos experimentais (ensaio clínico randomizado), manipula ativamente a exposição. Os estudos transversais são os de mais fácil realização, pois o fator em estudo e o desfecho são aferidos simultaneamente em uma população definida. Nos estudos de coorte, caracteriza-se a presença ou ausência do fator em estudo, e segue-se a população por um período de tempo suficiente para identificar a ocorrência do desfecho. Nos estudos de casos e controles, os participantes são selecionados pela presença ou ausência de doença, e investigam- se as exposições pregressas que possam associar-se com o desenvolvimeto desta doença. O ensaio clínico é o delineamento experimental que mais se assemelha ao experimento de laboratório e permite que o investigador determine quem será exposto.; Epidemiologic principles and methods have been widely employed in clinical research. The purpose of this paper is to discuss basic epidemiological concepts applied to the investigation of the determinants of infant diseases. The theoretical framework outlines the hypothesis of the investigation. The design of the study is chosen accordingly. Exposure and outcome are defined...

Os levantamentos epidemiológicos são importantes para o conhecimento da prevalência e tipologia das doenças bucais, podendo-se a partir dos dados coletados, planejar, executar e avaliar ações de saúde. É necessário, no entanto, que haja rigor metodológico que garanta reprodutibilidade, validade e confiabilidade, e que haja uniformidade de procedimentos para permitir comparações nacionais e internacionais. A iniciativa da Organização Mundial da Saúde (OMS) na assessoria à realização de levantamentos tem se mostrado extremamente útil, estimulando o estabelecimento de padrões de procedimentos que podem ser utilizados em todos os países. em 1991 foi publicada a edição em português da terceira edição do Oral Health Surveys - basic methods, de 1987, um manual que objetiva fornecer instruções para a realização de levantamentos epidemiológicos e tal publicação passou a servir de base a estudos realizados em diversos locais do Brasil e do mundo. O objetivo deste trabalho, é analisar criticamente a metodologia para Levantamento Epidemiológico em Saúde Bucal da OMS, na tentativa de contribuir para o aperfeiçoamento da mesma. de acordo com a presente análise, foram encontrados pontos relevantes para consideração...

The likelihood of an epidemiologic study correctly identifying an adverse health outcome associated with exposure to indoor air pollutants is increased if a) substantial variation exists in the frequency or level of exposure among study subjects otherwise at similar risk of the health outcome; b) the number of study subjects or study communities is large; c) the health outcome can be assessed with accuracy; d) relevant exposure levels can be measured with accuracy; e) an unbiased sample of exposed and nonexposed subjects is selected for study; and f) other determinants of the adverse health outcome can be measured. Nonetheless, given a strong enough impact of exposure to one pollutant or a mixture of pollutants on the risk of illness, it is possible for epidemiologic studies to discern a relation even if only some of the above circumstances are present.

Settings with limited health care workers are challenging environments for delivery of antiretroviral therapy. One strategy to address this human resource crisis is to task shift through training selected patients as peer health workers (PHWs) to provide care to other individuals receiving antiretroviral therapy. To better understand processes of a cluster-randomized trial on the effect of these PHWs on AIDS care, we conducted a mixed methods operations research evaluation. Qualitative methods involved patients, PHWs, and clinic staff and included 38 in-depth interviews, 8 focus group discussions, and 11 direct observations. Quantitative methods included staff surveys, process, and virologic data analyses. Results showed that task shifting to PHWs positively affected structural and programmatic functions of care delivery—improving clinical organization, medical care access, and patient-provider communication—with little evidence for problems with confidentiality and inadvertent disclosure. Additionally, this evaluation elucidated trial processes including evidence for direct and indirect control arm contamination and evidence for mitigation of antiretroviral treatment fatigue by PHWs. Our results support the use of PHWs to complement conventional clinical staff in delivering AIDS care in low-resource settings and highlight how mixed methods operations research evaluations can provide important insights into community-based trials.

Objective. Kuwait is among the countries with the highest obesity rates worldwide; however, little is known about the state of obesity epidemiology research in Kuwait. In this paper, we therefore review the findings and methodology of studies on the prevalence, trends and risk factors of obesity in Kuwait. Methods. The PubMed database was searched using the keyword combination: obesity and adults and Kuwait. Out of 111 articles, 39 remained after abstract review, and 18 were selected after full-text review. Results. The studies were all cross-sectional and published in the last fifteen years (1997–2012). The sample size ranged from 177 to 38,611 individuals. Only 30% of studies used random sampling. The prevalence (BMI ≥ 30) in studies with a nationally representative sample ranged from 24% to 48% overall and in adults >50 years was greater than 52%. Rates were significantly higher in women than those in men. Studies that examined trends showed an increase in obesity prevalence between 1980 and 2009. Multiple risk factors including sociocultural factors were investigated in the studies; however, factors were only crudely assessed. Conclusion. There is a need for future studies, particularly surveillance surveys and prospective cohort studies utilizing advanced methods...

Background: As an observational science, epidemiology is regarded by some researchers as inherently flawed and open to false results. In a recent paper, Boffetta et al. [Boffetta P, McLaughlin JK, LaVecchia C, Tarone RE, Lipworth L, Blot WJ. False-positive results in cancer epidemiology: a plea for epistemological modesty. J Natl Cancer Inst 100:988–995 (2008)] argued that “epidemiology is particularly prone to the generation of false-positive results.” They also said “the tendency to emphasize and over-interpret what appear to be new findings is commonplace, perhaps in part because of a belief that the findings provide information that may ultimately improve public health” and that “this tendency to hype new findings increases the likelihood of downplaying inconsistencies within the data or any lack of concordance with other sources of evidence.” The authors supported these serious charges against epidemiology and epidemiologists with few examples. Although we acknowledge that false positives do occur, we view the position of Boffetta and colleagues on false positives as unbalanced and potentially harmful to public health. Objective: We aim to provide a more balanced evaluation of epidemiology and its contribution to public health discourse.Discussion Boffetta and colleagues ignore the fact that false negatives may arise from the very processes that they tout as generating false-positive results. We further disagree with their proposition that false-positive results from a single study will lead to faulty decision making in matters of public health importance. In practice...

Background: Policymakers and researchers seek answers to how liberalized drug policies affect people who inject drugs (PWID). In response to concerns about the failing “war on drugs,” Mexico recently implemented drug policy reforms that partially decriminalized possession of small amounts of drugs for personal use while promoting drug treatment. Recognizing important epidemiologic, policy, and socioeconomic differences between the United States—where possession of any psychoactive drugs without a prescription remains illegal—and Mexico—where possession of small quantities for personal use was partially decriminalized, we sought to assess changes over time in knowledge, attitudes, behaviors, and infectious disease profiles among PWID in the adjacent border cities of San Diego, CA, USA, and Tijuana, Baja California, Mexico. Methods: Based on extensive binational experience and collaboration, from 2012–2014 we initiated two parallel, prospective, mixed methods studies: Proyecto El Cuete IV in Tijuana (n = 785) and the STAHR II Study in San Diego (n = 575). Methods for sampling, recruitment, and data collection were designed to be compatible in both studies. All participants completed quantitative behavioral and geographic assessments and serological testing (HIV in both studies; hepatitis C virus and tuberculosis in STAHR II) at baseline and four semi-annual follow-up visits. Between follow-up assessment visits...

Background: It is of critical importance to evaluate the role of environmental chemical exposures in premature birth. While a number of studies investigate this relationship, most utilize single exposure measurements during pregnancy in association with the outcome. The studies with repeated measures of exposure during pregnancy employ primarily cross-sectional analyses that may not be fully leveraging the power and additional information that the data provide. Methods: We examine 9 statistical methods that may be utilized to estimate the relationship between a longitudinal exposure and a binary, non-time-varying outcome. To exemplify these methods we utilized data from a nested case–control study examining repeated measures of urinary phthalate metabolites during pregnancy in association with preterm birth. Results: The methods summarized may be useful for: 1) Examining sensitive windows of exposure in association with an outcome; 2) Summarizing repeated measures to estimate the relationship between average exposure and an outcome; 3) Identifying acute exposures that may be relevant to the outcome; and 4) Understanding the contribution of temporal patterns in exposure levels to the outcome of interest. In the study of phthalates...

O desconhecimento pela vigilância epidemiológica de fração dos casos diagnosticados de tuberculose, implica em subestimativa da magnitude da doença, e portanto acarreta subalocação de ações e recursos para seu controle. Este trabalho teve como objetivo estimar a subnotificação ao SINAN de casos de tuberculose no Estado de Mato Grosso do Sul no período de 2000 a 2006 e verificar, entre os casos não notificados, a ocorrência de óbitos e a menção da doença entre as causas de morte. Foram comparadas as informações contidas nos bancos de dados do Laboratório Central de Saúde Pública (LACEN-MS), do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informação em Mortalidade (SIM). Os resultados mostraram subnotificação de 17,7% dos casos diagnosticados pelo LACEN-MS. Dos casos não notificados, 27% resultaram em óbito, todos estes encontrados nos registros do SIM. A tuberculose foi mencionada entre as causas de morte em 20,3% dos óbitos. Os resultados encontrados evidenciam a magnitude da subdimensão do sistema de vigilância epidemiológica da tuberculose no estado de Mato Grosso do Sul, levando a estimativas irreais das prevalências anuais dessa doença. Os óbitos entre os casos não notificados sugerem a ocorrência de diagnóstico tardio e a possibilidade destes pacientes não terem recebido tratamento algum.; ABSTRACT - Lack of information held by epidemiological surveillance services on a fraction of the diagnosed cases of tuberculosis causes the magnitude of the disease to be underestimated...

BACKGROUND AND OBJECTIVES Pathological and problem gambling may be common yet frequently undetected conditions in substance use treatment. This paper reports findings on the prevalence of gambling comorbidities in these clinical contexts that are generalizable across regions and settings. It indicates the implications of such conditions for treatment of substance use problems. METHODS A U.S. representative sample of n = 402 patients reporting past-year treatment for substance use problems was derived from wave 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses used to examine correlates of gambling symptoms. RESULTS Rates of lifetime pathological gambling (5+ DSM-IV symptoms) and problem gambling (3+ DSM-IV symptoms) were 4.3% (s.e. = 1.3%) and 7.2% (s.e. = 1.6%), respectively. Lifetime gambling symptoms were associated with Axis II disorders, but no Axis I diagnoses. There was limited evidence of associations with substance usage, mental or physical health and medical utilization. There were associations with financial crises and relationship breakdown, during and after treatment. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Gambling problems are elevated in substance use treatment but may be less common than previously thought; when considered nationally and across clinical settings. They may have modest associations with clinical characteristics given high levels of psychiatric severity that characterise treatment seeking samples overall. Notwithstanding...

Most studies of neighborhood effects on health have used the multilevel approach. However, since this methodology does not incorporate any notion of space, it may not provide optimal epidemiologic information when modeling variations or when investigating associations between contextual factors and health. Investigating mental disorders due to psychoactive substance use among all 65,830 individuals aged 40-59 years in 2001 in Malmö, Sweden, geolocated at their place of residence, the authors compared a spatial analytical perspective, which builds notions of space into hypotheses and methods, with the multilevel approach. Geoadditive models provided precise cartographic information on spatial variations in prevalence independent of administrative boundaries. The multilevel model showed significant neighborhood variations in the prevalence of substance-related disorders. However, hierarchical geostatistical models provided information on not only the magnitude but also the scale of neighborhood variations, indicating a significant correlation between neighborhoods in close proximity to each other. The prevalence of disorders increased with neighborhood deprivation. Far stronger associations were observed when using indicators measured in spatially adaptive areas...

Value of information (VOI) methods have been proposed as a systematic approach to inform optimal research design and prioritization. Four related questions arise that VOI methods could address. (i) Is further research for a health technology assessment (HTA) potentially worthwhile? (ii) Is the cost of a given research design less than its expected value? (iii) What is the optimal research design for an HTA? (iv) How can research funding be best prioritized across alternative HTAs? Following Occam's razor, we consider the usefulness of VOI methods in informing questions 1–4 relative to their simplicity of use. Expected value of perfect information (EVPI) with current information, while simple to calculate, is shown to provide neither a necessary nor a sufficient condition to address question 1, given that what EVPI needs to exceed varies with the cost of research design, which can vary from very large down to negligible. Hence, for any given HTA, EVPI does not discriminate, as it can be large and further research not worthwhile or small and further research worthwhile. In contrast, each of questions 1–4 are shown to be fully addressed (necessary and sufficient) where VOI methods are applied to maximize expected value of sample information (EVSI) minus expected costs across designs. In comparing complexity in use of VOI methods...

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study's objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance...

Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected comparatively less citations. Results offer a rich picture of the academic influences and trends of epidemiologic methods and reasoning on public health, clinical medicine and the other health, life and social sciences. They may contribute to assess epidemiologists' efforts to demarcate epidemiology and to assert epistemic authority...

OBJETIVO: Descrever os métodos utilizados no estudo longitudinal e acompanhamento das crianças nascidas em Pelotas (RS) em 1982. MÉTODOS: A coorte foi iniciada com um inquérito de saúde perinatal de todas as 6.011 crianças nascidas nas maternidades de Pelotas em 1982. As 5.914 crianças nascidas vivas foram incluídas nos estudos de acompanhamento. Até 2004-5 foram realizados oito acompanhamentos, com a aplicação de questionários às mães e/ou aos membros da coorte, conforme a faixa etária. Exames antropométricos e clínicos foram realizados nas visitas. Os participantes da coorte são descritos conforme variáveis demográficas, socioeconômicas e de saúde colhidas nos primeiros acompanhamentos, que são utilizadas como variáveis de exposição. RESULTADOS: A maior parte dos jovens da coorte foram acompanhados durante 23 anos de vida e distintas visitas. Os acompanhamentos que obtiveram maior êxito foram aqueles precedidos por um censo da cidade. Com este método foram localizados 87,2% em 1984 (idade média de 19 meses), 84,1% em 2006 (média 43 meses), e 77,4% em 2004-5 (média 23 anos). CONCLUSÕES: Estudos de coorte de nascimentos podem ser realizados com sucesso em países em desenvolvimento, e a metodologia empregada nesses estudos de ciclo vital permite estudar a influência de exposições precoces sobre a determinação das doenças da vida adulta.; OBJETIVO: Describir los métodos utilizados en el estudio longitudinal y acompañamiento de los niños nacidos en Pelotas (Sur de Brasil) en 1982. MÉTODOS: La cohorte fue iniciada con una investigación de salud perinatal de todos los 6.011 niños nacidos en las maternidades de Pelotas en 1982. Los 5.914 niños nacidos vivos fueron incluidos en los estudios de acompañamiento. Hasta 2004-5 fueron realizados ocho acompañamientos...

Com o objetivo de verificar a maneira mais eficaz para descobrir e tratar casos de tuberculose pulmonar, um modelo matemático foi aplicado à demanda do Centro de Saúde de Ribeirão Preto, São Paulo (Brasil). As 30.855 pessoas residentes com 15 ou mais anos de idade que se matricularam entre maio de 1973 e abril de 1974 foram submetidas ao teste tuberculínico, abreugrafia e exame bacteriológico do escarro (nos sintomáticos). Os resultados forneceram a composição epidemiológica da demanda, constituída por cinco categorias mutuamente exclusivas: 1 - não infectado: 61,14%; 2 - infectados: 37,84%; 3 - suspeitos à abreugrafia: 0,83%; 4 - casos positivos apenas à cultura: 0,07%; 5 - casos baciloscopia-positivos: 0,12%. Paralelamente calcularam-se os custos médios unitários dos exames e do tratamento no Centro de Saúde. Com esses dados, o modelo matemático proposto por Revelle e Male, modificado neste trabalho, foi aplicado para o cálculo do custo por caso ativo tratado segundo todas as combinações lógicas possíveis dos exames citados. A estratégia mais adequada à demanda estudada, nas condições administrativas vigentes, definida por critérios econômico, epidemiológico e clínico foi a seguinte: inicialmente teste tuberculínico em toda a demanda; a seguir...

Ainda que sua 'morte' tenha sido freqüentemente certificada, os livros continuam sendo relevantes para muitas profissões e disciplinas acadêmicas. Análises de citações recebidas por textos epidemiológicos podem complementar outras visões em epidemiologia. O objetivo do estudo foi avaliar o número de citações recebidas por alguns livros de epidemiologia e saúde pública, como um primeiro passo para estudar a influência do pensamento epidemiológico e o pensar da academia. Para este propósito, a base de dados do Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledge foi consultada em maio de 2006. O livro de Rothman & Greenland recebeu o maior número de citações no total (mais de 8.000) e por ano. Os livros de Kleinbaum et al, e de Breslow & Day tiveram em torno de 5.000 citações. Em termos de citações por ano, o livro de Sackett et al ocupou o terceiro lugar, e o de Rose, o quarto entre os incluídos no estudo. Outros livros que tiveram influência em salas de aula, comparativamente, tiveram menos citações. Os achados oferecem um rico retrato das influências acadêmicas e tendências de métodos epidemiológicos e interpretação em saúde pública, medicina clínica e outras ciências da saúde...

Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected comparatively less citations. Results offer a rich picture of the academic influences and trends of epidemiologic methods and reasoning on public health, clinical medicine and the other health, life and social sciences. They may contribute to assess epidemiologists' efforts to demarcate epidemiology and to assert epistemic authority...