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‣ Molecular epidemiology: The impact of molecular biology in epidemiology research

Dorman,Janice S
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2000 Português
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Progress in molecular biology and genetics is changing the practice of medicine and public health through the development of molecular diagnostics and targeted interventions for susceptible individuals. The ethical, legal and social issues that are becoming apparent as these important discoveries are introduced into practice will have an enormous impact on society. The accurate translation of this new genetic information from the laboratory to the community is an urgent need. Molecular epidemiology is at the foundation of this important link, and represents the scientific basis of public health for the 21st Century. (Rev Méd Chile 2000; 128: 1261-68)

‣ Estudio neuroepidemiológico en Aratoca, una área rural del oriente colombiano

Pradilla Ardila,Gustavo; Vesga Angarita,Boris Eduardo; León-Sarmiento,Fidias Eugenio
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2002 Português
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Background: Current health statistics on the prevalence of neurological diseases, in Colombia, are still lacking. Aim: To determine the prevalence of migraine, cerebrovascular disease, movement disorders, peripheral neuropathies, mental retardation and developmental disorders, epilepsy, dementia and sequels of cranial trauma in a rural population of Colombia. Materials and methods: We evaluated 544 subjects in Aratoca, a rural place of Santander, placed at 400 kilometers from Bogota. The world health organization (WHO) protocol for neuroepidemiological studies modified by our group, a survey to determine sequels of cranial trauma and the mini mental state examination were used as instruments. People 12 years-old or more and suspected to have a neurological disease was evaluated by adult neurologists and those less than 12 years-old were evaluated by a neuropediatrician. Results: 223 out of 544 subjects surveyed were evaluated by the clinicians of which 135 had a neurological disorder. The prevalence of neurological diseases, per thousand inhabitants were as follows: migraine 189.3; epilepsy 33; febrile seizures 25.6; peripheral neuropathy 22.1; mental retardation 18.4; developmental and language disorders 11; dementia 10.5; cerebrovascular disease 4.7; and movement disorders 3.7. Conclusions: These results will allow to define appropriate control measures...

‣ Características de la tuberculosis en pacientes mayores de 65 años en el área sanitaria de Cádiz (España)

López-Pelayo,Irache; García-Martos,Pedro; Saldarreaga,Abel; Montes de Oca,Montserrat; Moreno,Isabel; González-Moya,Enrique
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2004 Português
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Background : Tuberculosis in the elderly is an increasing public health problem. Aim: To describe the epidemiological, clinical and microbiological characteristics of tuberculosis in patients over 65 years old, as compared to younger patients. Material and methods: We reviewed the case histories of tuberculosis, microbiologically diagnosed by Ziehl-Neelsen/auramine smear and Löwenstein-Jensen culture, in patients over 65 years old, in the sanitary area of Cadiz (Spain). Results: We detected 49 new cases (37 males) of tuberculosis in elderly subjects. The infection rate in this age group (16.3/100.000 inhabitants) is lower than in people younger than 65 years old (21.1/100.000 inhabitants). The most common symptoms were cough (44.9%), fever (40.8%) and dyspnea (44.9%). Neither of them were infected by the human immunodeficiency virus nor were parenteral drug abusers. Thirty seven percent of cases had a history of previous tuberculosis, and in 75.5% the disease location was pulmonary. The Ziehl-Neelsen/auramine smear was negative in 53.1% of the samples. Conclusions: The number of patients older than 65 years old with tuberculosis has increased in the sanitary area of Cadiz (Spain). This group of patients shows different epidemiological and clinical characteristics than younger patients (Rev Méd Chile 2004; 132: 325-30).

‣ Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics

Poves Martínez,Elvira; Pozo Prieto,David del; Costero Pastor,Belén; Borrego Rodríguez,Gloria; Beceiro Pedroño,Inmaculada; Sanz García,Cecilia; Busteros Buraza,José Ignacio; González Palacio,M.ª Rosa
Fonte: Revista Española de Enfermedades Digestivas Publicador: Revista Española de Enfermedades Digestivas
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/01/2012 Português
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Objective: to analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital. Patients and methods: we performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patients who required liver biopsy. Results: we diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D...

‣ Epidemiologic study on the current incidence of inflammatory bowel disease in Madrid

López-Serrano,P.; Pérez-Calle,J. L.; Carrera-Alonso,E.; Pérez-Fernández,T.; Rodríguez-Caravaca,G.; Boixeda-de-Miguel,D.; Fernández-Rodríguez,C. M.
Fonte: Revista Española de Enfermedades Digestivas Publicador: Revista Española de Enfermedades Digestivas
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/11/2009 Português
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Introduction: the incidence of inflammatory bowel disease (IBD) varies widely according to geographical area and has been reported to have increased in the last few years. No data are available on the current incidence of this disease in Madrid (Spain). Aim: to determine the incidence of inflammatory bowel disease in the area of influence of University Hospital Fundación Alcorcón (Madrid), and to compare our results with those from other Spanish and European series. Patients and methods: a prospective, population-based study was performed to determine the incidence of IBD in the area of University Hospital Fundación Alcorcón in Madrid between 2003 and 2005. Total population: 213,587 inhabitants (177,490 older than 14 years). Crude rates and age- and sex-specific rates adjusted to the European standard population were calculated. A retrospective study (1998-2003) was also performed. Results: a total of 69 cases were diagnosed -Crohn's disease (CD): 35, ulcerative colitis (UC): 33, indeterminate colitis: 1- in the prospective period. Crude rates of CD and UC were 7.92 and 7.47 cases/100,000 inhabitants/year, respectively (the population aged 0-14 years). Specific rates were 8.0 (95% CI, 7.03-8.97) and 7.47 (95% CI, 6.5-8.4), respectively. Mean age at diagnosis was 31.02± 10.76 and 39.91±16.19 years for CD and UC...

‣ Population-based versus hospital-based controls: are they comparable?

Ruano-Ravina,Alberto; Pérez-Ríos,Mónica; Barros-Dios,Juan Miguel
Fonte: Gaceta Sanitaria Publicador: Gaceta Sanitaria
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/12/2008 Português
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Objective: To compare whether there are differences among hospital and population controls. Methods: Two case-control studies were conducted on lung cancer risk factors in the Santiago de Compostela Public Health District. Whereas one used randomly chosen census-based population controls, the other used consecutive hospital controls that went to the reference hospital for non-smoking-related trivial interventions. The differences were analyzed using logistic regression. The dependent variable was type of control (hospital or population). Results: Hospital controls had a similar tobacco habit than population controls, but consumed more alcohol. For those consuming more than 50 ml daily, the risk of being a hospital control was 4.83 (95%CI: 2.55-9.14). Conclusions: There may be some differences between hospital and population-based controls, which must be taken into account in the design of case-control studies. It is necessary to ascertain whether such differences are reproduced at other geographic locations and whether they can affect estimation of exposure-disease.

‣ Epidemiological studies are like cherries, one draws another

Lunet,Nuno
Fonte: Gaceta Sanitaria Publicador: Gaceta Sanitaria
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/10/2009 Português
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The proverb "Words are like cherries", meaning that when you start talking subjects pop up and you end up with long conversations, just like cherries coming out of the plate in chains when you pick one, may also be applied to epidemiological research. A sequence of epidemiological studies, each being drawn from the previous, is presented as an example of how each investigation may raise new questions to be addressed in following studies. This description stresses the need for appropriate planning and the usefulness of pilot testing to depict inadequacies that can hardly be anticipated without field work. I intend to illustrate how epidemiological research can provide a deep approach to research questions, as long as findings are properly interpreted and suboptimal methodological options are taken into account in future investigations.

‣ Energy and nutrient consumption in Mexican women 12-49 years of age: analysis of the National Nutrition Survey 1999

Barquera,Simón; Rivera,Juan A; Espinosa-Montero,Juan; Safdie,Margarita; Campirano,Fabricio; Monterrubio,Eric A
Fonte: Instituto Nacional de Salud Pública Publicador: Instituto Nacional de Salud Pública
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 Português
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OBJECTIVE: To describe the reported energy and nutrient intake and adequacies in Mexican women. MATERIAL AND METHODS: A 24-hour dietary recall was used to obtain nutrient intake in a representative sub-sample of 2 630 women from 12 to 49 years of age from the National Nutrition Survey 1999. Nutrient adequacies were estimated using the Dietary Reference Intakes and stratified according to region, area (urban or rural), socioeconomic status and obesity status (non-obese: BMI <30 kg/m², obese: >30 kg/m²). Differences were analyzed using linear regression for complex surveys of log-transformed intake and adequacy, adjusting for multiple comparisons with the Bonferroni test. RESULTS: The median national energy intake was 1 471 kcal. The Risk of Inadequacy (RI) (prevalence of adequacy <50%) was: vitamin A:38.3%, vitamin C: 45.5%, and folate: 34.3%. Carbohydrates, folate, iron and calcium intake was significantly higher in rural than in urban areas. The RI was higher in women of the lowest socioeconomic status tertile for all nutrients with the exception of carbohydrates and calcium. Macro-nutrient adequacies were significantly higher in non-obese women. CONCLUSIONS: Differences within the country among regions, rural and urban areas, and socioeconomic status tertile reflect an increasing availability of inexpensive calorie-dense foods in marginal groups. However...

‣ Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators

Barcellos,Christovam; Acosta,Lisiane Morelia Weide; Lisboa,Eugenio; Bastos,Francisco Inácio
Fonte: Faculdade de Saúde Pública da Universidade de São Paulo Publicador: Faculdade de Saúde Pública da Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2009 Português
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OBJECTIVE: To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS: Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS: There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services. CONCLUSIONS: Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.

‣ Leisure-time physical activity during pregnancy in the 2004 Pelotas Birth Cohort Study

Domingues,Marlos Rodrigues; Barros,Aluísio J D
Fonte: Faculdade de Saúde Pública da Universidade de São Paulo Publicador: Faculdade de Saúde Pública da Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2007 Português
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OBJECTIVE: Physical activity during pregnancy is a poorly investigated subject on population level. The study aimed to describe duration, type and frequency of leisure-time physical activity during pregnancy, and to explore its associated factors. METHODS: A population-based study was carried out during 2004 in Southern Brazil. A total of 4,471 mothers were interviewed soon after delivery. Physical activity was measured using a questionnaire, developed for the study. Results were obtained by Poisson regression. RESULTS: In the sample, 14.8% of women reported to engage in some type of physical activity prior to pregnancy and 12.9% during pregnancy. In the first trimester, 10.4% of all mothers engaged in some type of physical activity; 8.5% in the second trimester and 6.5% in the third trimester. Only 194 mothers (4.3%) were active during the whole pregnancy. In the adjusted analysis, leisure-time physical activity was positively associated with schooling, physical activity advice during prenatal care, and family income (p<0.001), being employed during pregnancy (p=0.05), and number of pregnancies (p=0.02). Walking was the most frequent activity. CONCLUSIONS: The prevalence of leisure-time physical activity is low among Brazilian pregnant women. Although physical activity is not perceived as being pregnancy-threatening...

‣ Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico

McConnell,K. John; Gubler,Duane J.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2003 Português
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OBJECTIVE: In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. DESIGN AND METHODS: Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition...

‣ Single lesion as an indicator to monitor the leprosy trend to elimination in hyperendemic areas

Ignotti,Eliane; Bayona,Manuel; Alvarez-Garriga,Carolina; Andrade,Vera L.G.; Valente,Joaquim G.
Fonte: Associação Brasileira de Pós -Graduação em Saúde Coletiva Publicador: Associação Brasileira de Pós -Graduação em Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2007 Português
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INTRODUCTION: Prevalence and detection rates of leprosy are not sufficient to show the real magnitude of changes in epidemiological patterns. OBJECTIVES: Evaluate the feasibility and usefulness of the proportion of new leprosy patients with a single skin lesion (SSL) as a potential indicator of the elimination of leprosy. METHODS: We conducted a retrospective study based on secondary data analyzing newly reported cases of leprosy between 1997 and 2002, in the city of Palmas, Tocantins, Brazil. Patients with a single lesion were compared to remaining patients, and the odds ratio was used as measure of association. RESULTS: Out of the 1,303 new cases of leprosy, 481 (36.9%) had a SSL. An increasing time-trend was observed in the proportion of new cases detected with a single lesion, which grew from 20.3% in 1999 to 49.1% in 2002 (linear trend p<.001) while a reduction in the number of new cases was observed simultaneously after 1999. The proportion of patients with a single lesion was higher in women, young age, paucibacillary, tuberculoid and indeterminate clinical forms, residents of urban areas, those with negative baciloscopy, with macular lesions, without physical disabilities, and mainly detected in primary health care units. CONCLUSIONS: These findings confirm that the proportion of patients with a SSL can be used as a sensitive and feasible indicator to assess the progress of the elimination of leprosy in hyperendemic areas.

‣ Retinol binding protein 4 and incident diabetes the Atherosclerosis Risk in Communities Study (ARIC Study)

Luft,Vivian C.; Pereira,Mark; Pankow,James S.; Ballantyne,Christie; Couper,David; Heiss,Gerardo; Duncan,Bruce B.
Fonte: Associação Brasileira de Pós -Graduação em Saúde Coletiva Publicador: Associação Brasileira de Pós -Graduação em Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2013 Português
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Background: Retinol binding protein 4 (RBP4) has been described as a link between impaired glucose uptake in adipocytes and systemic insulin sensitivity. Objective: To determine whether RBP4 fasting levels predict the development of type 2 diabetes. Methods: Using a case-cohort design, we followed 543 middle-aged individuals who developed diabetes and 537 who did not over ~9 years within the population-based Atherosclerosis Risk in Communities Study. Weighted Cox proportional hazards analyses permitted statistical inference of the RBP4 – incident diabetes associations to the entire cohort. Results: Women in the highest tertile of RBP4 presented greater risk of developing diabetes (HR = 1.74; 95%CI 1.03 – 2.94) in analyses adjusted for age, ethnicity, study center, parental history of diabetes, hypertension, glomerular filtration rate, body mass index, waist-hip ratio, nonesterified fatty acids, adiponectin, leptin, triglycerides and HDL-C. When additionally adjusted for fasting insulin, this association's significance became borderline (HR = 1.68; 95%CI 1.00 – 2.82). No association between RBP4 levels and incident diabetes was found in men. Conclusion: These findings suggest that RBP4 levels may be directly involved in the pathogenesis of type 2 diabetes in women.

‣ Epidemiological studies are like cherries, one draws another

Lunet,Nuno
Fonte: Ediciones Doyma, S.L. Publicador: Ediciones Doyma, S.L.
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2009 Português
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The proverb "Words are like cherries", meaning that when you start talking subjects pop up and you end up with long conversations, just like cherries coming out of the plate in chains when you pick one, may also be applied to epidemiological research. A sequence of epidemiological studies, each being drawn from the previous, is presented as an example of how each investigation may raise new questions to be addressed in following studies. This description stresses the need for appropriate planning and the usefulness of pilot testing to depict inadequacies that can hardly be anticipated without field work. I intend to illustrate how epidemiological research can provide a deep approach to research questions, as long as findings are properly interpreted and suboptimal methodological options are taken into account in future investigations.

‣ The tobacco dependence dimension in Colombia

Posada-Villa,Jose; Cheng,Hui G.; Martins,Silvia S.; Storr,Carla L.; Aguilar-Gaxiola,Sergio A.; Anthony,James C.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 Português
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This epidemiological study of a sample of smokers from the general population of Colombia examined the population distribution and dimensionality of eight hypothesized inter-correlated clinical features (CFs) associated with tobacco dependence syndrome (TDS). Data were drawn from interviews of 4 426 smokers conducted in a national survey in Colombia as part of the World Mental Health Survey Initiative. Daily smokers completed a Spanish-language TDS module, and the 237 smokers who had begun smoking during the five years prior to the assessment were selected. Confirmatory factor analysis (CFA) for a unidimensional TDS provided discrimination and difficulty parameter estimates. Two CFs that were reported very infrequently among the study sample were dropped from the CFA. Among the six remaining CFs, discrimination (D1) estimates ranged from 1.1 to 6.0 and difficulty (D2) estimates ranged from 1.1 to 2.2, providing evidentiary support for a unidimensional tobacco dependence construct. The Spanish-language TDS module used in this study could serve as a valuable tool in future studies for evaluating public health outreach and early intervention programs directed toward community residents who have begun smoking tobacco.

‣ Metabolic changes associated with antiretroviral therapy in HIV-positive patients

Almeida,Sabrina Esteves de Matos; Borges,Michele; Fiegenbaum,Marilu; Nunes,Cynara Carvalho; Rossetti,Maria Lucia Rosa
Fonte: Faculdade de Saúde Pública da Universidade de São Paulo Publicador: Faculdade de Saúde Pública da Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2009 Português
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OBJECTIVE: To evaluate metabolic changes associated with highly active antiretroviral therapy (HAART) in HIV-positive patients, and to identify risk factors associated. METHODS: Retrospective study that included 110 HIV-positive patients who where on HAART in the city of Porto Alegre (Southern Brazil) between January 2003 and March 2004. Data on demographic variables, cigarette smoking, diabetes mellitus, cholesterol and triglyceride levels, stage of HIV infection, antiretroviral therapy and HCV coinfection were collected. General linear models procedure for repeated measures was used to test the interaction between HAART and HCV coinfection or protease inhibitor treatment. RESULTS: Total cholesterol, triglycerides, and glucose levels significantly increased after receiving HAART (p<0.001 for all variables), but no interaction with protease inhibitors was seen for total cholesterol, glucose and triglyceride levels (interaction treatment*protease inhibitors p=0.741, p=0.784, and p=0.081, respectively). An association between total cholesterol levels and HCV coinfection was found both at baseline and follow-up (effect of HCV coinfection, p=0.011). Glucose levels were increased by HAART (treatment effect, p=0.036), but the effect was associated to HCV coinfection (treatment*HCV effect...

‣ Anticipating rotavirus vaccines: review of epidemiologic studies of rotavirus diarrhea in Argentina

Gómez,Jorge A.; Nates,Silvia; De Castagnaro,Nelda R.; Espul,Carlos; Borsa,Ana; Glass,Roger I.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/1998 Português
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Rotavirus is the most common cause of severe diarrhea in children worldwide, and vaccines currently being field-tested could be available for childhood immunization in several years. To assess the rotavirus disease burden in Argentina and the value of future national surveillance for the disease, we reviewed available data on rotavirus detections reported by published and unpublished studies conducted in nine Argentine cities and by a multicenter study. Data from these studies indicated that rotavirus was detected in 20% of 5 226 specimens (within a range of 6% to 54% for different studies) from children hospitalized for diarrhea and in 9% of 6 587 specimens (within a range of 5% to 22% for different studies) from children who were outpatients, members of mixed populations (hospitalized patients and outpatients), or survey subjects in community-based studies. The hospital data showed that while rotavirus was detected throughout the year, a peak occurred during the winter months (May­July), when up to half of the children with diarrhea were found positive for rotavirus. Attempted serotyping of 294 rotavirus-positive specimens for G-protein by three laboratories was successful in 230 cases (78%); the resulting data indicated that serotype G1 was the most common (being present in 60% of the successfully serotyped specimens)...

‣ A critical examination of summary measures of population health

Murray,Christopher J.L.; Salomon,Joshua A.; Mathers,Colin
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2000 Português
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In the past decade, interest has been rising in the development, calculation and use of summary measures of population health, which combine information on mortality and non-fatal health outcomes. This paper reviews the issues and challenges in the design and application of summary measures and presents a framework for evaluating different alternatives. Summary measures have a variety of uses, including comparisons of health in different populations and assessments of the relative contributions of different diseases, injuries and risk factors to the total disease burden in a population. Summary measures may be divided into two broad families: health expectancies and health gaps. Within each family, there are many different possible measures, but they share a number of inputs, including information on mortality, non-fatal health outcomes, and health state valuations. Other critical points include calculation methods and a range of conceptual and methodological issues regarding the definition, measurement and valuation of health states. This paper considers a set of basic criteria and desirable properties that may lead to rejection of certain summary measures and the development of new ones. Despite the extensive developmental agenda that remains...

‣ Active surveillance for congenital rubella syndrome in Yangon, Myanmar

Thant,Kyaw-Zin; Oo,Win-Mar; Myint,Thein-Thein; Shwe,Than-Nu; Han,Aye-Maung; Aye,Khin-Mar; Aye,Kay-Thi; Moe,Kyaw; Thein,Soe; Robertson,Susan E
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2006 Português
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OBJECTIVE: Rubella vaccine is not included in the immunization schedule in Myanmar. Although surveillance for outbreaks of measles and rubella is conducted nationwide, there is no routine surveillance for congenital rubella syndrome (CRS). Therefore, we organized a study to assess the burden of CRS. METHODS: From 1 December 2000 to 31 December 2002 active surveillance for CRS was conducted among children aged 0-17 months at 13 hospitals and 2 private clinics in Yangon, the capital city. Children with suspected CRS had a standard examination and a blood sample was obtained. All serum samples were tested for rubella-specific IgM; selected samples were tested for rubella-specific IgG and for rubella RNA by reverse transcriptase-polymerase chain reaction (RT-PCR). FINDINGS: A total of 81 children aged 0-17 months were suspected of having CRS. Of these, 18 children had laboratory-confirmed CRS (7 were IgM positive; 7 were RT-PCR positive; and 10 were IgG positive at > 6 months of age). One additional child who tested positive by RT-PCR and whose mother had had rubella during pregnancy but who had a normal clinical examination was classified as having congenital rubella infection. During 2001-02 no rubella outbreaks were detected in Yangon Division. In the 31 urban townships of Yangon Division...

‣ Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial

Khan,Mohammad Imran; Sahito,Shah Muhammad; Khan,Mohammad Javed; Wassan,Shafi Mohammad; Shaikh,Abdul Wahab; Maheshwari,Ashok Kumar; Acosta,Camilo J; Galindo,Claudia M; Ochiai,Rion Leon; Rasool,Shahid; Peerwani,Sheeraz; Puri,Mahesh K; Ali,Mohammad; Zafar,Af
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2006 Português
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INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described. METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis. RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI...