Chi-square Test For Linear Trend Research Articles

Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, eastern Ethiopia

BackgroundDespite efforts at curbing maternal morbidity and mortality, developing countries are still burdened with high rates of maternal morbidity and mortality. Ethiopia is not an exception and has one of the world’s highest rates of maternal deaths. Reducing the huge burden of maternal mortality remains the single most serious challenge in Ethiopia. There is a paucity of information with regards to the local level magnitude and causes of maternal mortality. We assessed the magnitude, trends and causes of maternal mortality using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia.MethodThe analysis used surveillance data extracted from the Kersa HDSS database for the duration of 2008 to 2014. Data on maternal deaths and live births during the seven year period were used to determine the maternal mortality ratio in the study. The data were mainly extracted from a verbal autopsy database. The sample was comprised of all reproductive aged women who died during pregnancy, childbirth or 42 days after delivery. Chi-squared test for linear trend was used to examine the significance of change in rates over time.ResultsOut of the total 311 deaths of reproductive aged women during the study period, 72 (23.2%) died during pregnancy or within 42 days of delivery. The overall estimated maternal mortality ratio was 324 per 100,000 live births (95% CI: 256, 384). The observed maternal mortality ratio has shown a declining trend over the seven years period though there is no statistical significance for the reduction (χ2 = 0.56, P = 0.57). The estimated pregnancy related mortality ratio was 543 per 100,000 live births (95% CI: 437, 663). Out of those who died due to pregnancy and related causes, only 26% attended at least one antenatal care service. The most common cause of maternal death was postpartum haemorrhage (46.5%) followed by hypertensive disorders of pregnancy (16.3%).ConclusionThe magnitude of maternal mortality is considerably high but has shown a decreasing trend. Community-based initiatives that aim to improve maternal health should be strengthened further to reduce the prevailing maternal mortality. Targeted information education and communication should be provided.

Knowledge and attitudes of Brazilian dentists regarding dental treatment of children

OBJECTIVE: This survey assessed the attitudes of dentists regarding dental treatment of children, the barriers reported, and knowledge about the recommended age for a child’s first dental visit.METHODS: A self-applied questionnaire was sent to all dentists in Pelotas/Brazil and 187 (67.8%) were returned. The chi-square test was used to analyze categorical or nominal variables; the chisquare test for linear trend was used for the ordinal variables and Fisher’s exact test was used when the cell frequencies were small. The level of significance was set at α=0.05.RESULTS: The majority of the dentists provide dental treatment for children (123; 71.9%). Regarding the barriers to treatment of children, behavior (55.9%) and interest of parents (48.2%) were the most cited. Only 65.9% reported that children should see a dentist no later than 12 months of age. Knowledge about the recommended age was higher among pediatric dentists (p=0.03) and lower among dentists in private practice (p=0.002) and with more years of practice (p=0.02).CONCLUSIONS: Although most of the dentists treat children, barriers have been pointed out. Many of the dentists are not aware of the recommended age for the first dental visit. Given the benefits of early treatment, this attitude should be stimulated among dental professionals.

The value of neuroimaging team meetings for patients in a district general hospital

Neuroradiologists provide quality-assured neuroimaging ­reports. We developed the use of a neuroimaging team meeting to provide second-opinion reporting by neuroradiologists on neuroimaging that had previously been reported by general ­radiologists. Neuroimaging from selected patients was reviewed at the meeting. Where there were discrepancies between an original report from a general radiologist and the report obtained from the meeting involving a neuroradiologist, we classified the discrepancies, recorded the scan modality ­involved and used the data to assess temporal trends in discrepancy rates. Over 4 years, 562 patients (312 women, 250 men, mean age 50.6 [SD 17.3] years) were studied. Agreement occurred for 396 (70.5%) patients. Discrepancies that were not clinically important occurred for 60 (10.7%) patients. Clinically important discrepancies were found for 106 (18.9%) patients: missed lesions for 47 (8.3%) patients and misinterpretations for 59 (10.5%) patients. Cerebrovascular disease was the most common reason for a recommendation of neuroimaging review at a meeting. Scan modality did not influence the frequency of discrepancies. Discrepancy rates decreased with time (chi-squared test for linear trend p=0.015), while the frequency of neuroradiologists’ recommendations for new investigations was stable at one in seven patients. Neuroimaging team meetings can facilitate improvements in neurology diagnoses.

Anti-müllerian hormone levels are associated with live birth rates in ART, but the predictive ability of anti-müllerian hormone is modest

ObjectivesThe aim was to evaluate the association between serum Anti-Müllerian Hormone (AMH) level and cumulative live birth rates (LBR) in patients undergoing their first in vitro fertilization (IVF) treatment cycle, and to compare serum AMH levels with Antral Follicle Count (AFC) and Ovarian Sensitivity Index (OSI) as predictors of live birth. Study designA prospective cohort study of 454 patients under the age of 40 and with a regular menstrual cycle of 21-35 days, undergoing their first IVF treatment cycles between September 2010 and June 2015. Participants were divided into three groups based on their AMH level, (AMH ≤10, AMH 10-<30 and AMH ≥30 pmol/l). Any difference in AMH-distribution between patients with or without live birth was analyzed using a Mann-Whitney-test, and live birth rates were compared between groups by a chi-squared test for linear trend. The ability of AMH, OSI and AFC as predictors of live birth was assessed by a receiver operating characteristics-analysis and the area under the curve (AUC) was calculated. ResultsPatients with live birth had a higher AMH, median (range) 26 [0-137] pmol/l, compared with patients without live birth, AMH 22 [0-154] pmol/l, p = 0.035. Mean live birth rate (SD) was 0.36 (0.48) in the total cohort, 0.26 (0.44) in AMH-group <10, 0.34 (0.48) in AMH-group 10-<30, and 0.41(0.49) in AMH-group ≥30. Thus live birth rates increased with 8% per AMH-group (95% CI: 0.02 −0.14, p = 0.015). The AUC for AFC was 0.56, for AMH 0.57 and for OSI 0.63, respectively. ConclusionAMH concentration in serum is associated with live birth rates after IVF. Our results suggest that both AMH, AFC and OSI have an equal but modest predictive ability in relation to live birth rate.

A retrospective study of the utility of targeted phototherapy in vitiligo.

Targeted phototherapy is a recent advance in the treatment of vitiligo, involving selective treatment of vitiligo patches with no effect on surrounding areas. Although it has been in use for a few years, little data is available regarding its safety and efficacy. A retrospective study to determine efficacy and safety of targeted phototherapy in vitiligo. One hundred and thirty four patients (male: 53, female: 81) who received targeted phototherapy and completed 11 or more sittings were included. Treatment was given once a week using the Lumera phototherapy system, a broadband ultraviolet B source, starting at 150 mJ/spot and after excluding a sunburn reaction, with increments of 50 mJ every week up to a maximum of 1000 mJ/patch. Chi-square test for linear trends was used for statistical analysis. The most common sites involved were the legs and a majority (70.9%) had non-segmental vitiligo. Response was mild in 78 (58.2%) patients, moderate in 50 (37.3%) and excellent in 6 (4.5%) patients. Response was directly proportional to the number of sittings with more patients showing moderate and excellent responses with an increase in the number of sittings. The most common site for an excellent response was the trunk while the lower limbs were involved in most cases with a moderate or mild response. Side effects were seen in 27 (20.2%) patients, the commonest being erythema. This is a retrospective uncontrolled study. Further, the effects of adjuvant treatment were not assessed. Targeted phototherapy is a useful treatment for vitiligo with mild adverse effects, though response is mild or moderate and appears to be directly proportional to the number of treatments received.

HIV prevalence trend from HIV sentinel surveillance over a decade in India: An overview.

We aim to describe trends in antenatal HIV prevalence in India, at a national and regional level from consistent sentinel surveillance sites (2003-2015) among Antenatal Clinic (ANC) attendees. Data were analyzed from a total of 1,885,207 ANC attendees recruited at ANC sites. The consistent sites were grouped by years of initiation (Group 1: 2003-2005 and Group 2: 2006-2008) and according to six regions. Chi-square test for linear trend was applied to test the statistical significance of the trend. Nationally, at Group 1 sites, HIV prevalence was 0.93% in 2003, which declined to 0.36% in 2015 (P < 0.001). Similarly, at Group 2 sites, prevalence ranged from 0.25% to 0.23% during 2006-2015 (P > 0.05). The findings suggest that HIV is conclusively declining at old sites, nationally as well as in most of the other regions but increasing in the northern region. At newer sites, the conclusive declining trend is evident only in the southern region. National AIDS response must consider these variations to allow locally appropriate responses to the epidemic.

The prevalence of tooth wear and its associated risk factors in Indian South West coastal population: An epidemiological study

Background: The aim of the study was to estimate the prevalence of tooth wear in South West Coastal population of India and to investigate the risk factors associated with it. Materials and Methods: This study was conducted in the Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, and the rural satellite centers during June 2016–August 2016. A total of 1000 patients were evaluated for the presence of attrition, abrasion, erosion, and abfraction followed by the questionnaire to evaluate risk factors associated with it. The data were statistically analyzed using SPSS version 22.0 software. Statistical analysis was carried out by applying Chi-square test for linear trend. Results: Total prevalence of tooth wear in the study population was 40.6% of which attrition (29%), abrasion (23.7%), erosion (4.6%), and abfraction (6.3%) were observed. The tooth wear was more prevalent in the age group of 40–60 years. Males and urban population showed higher tooth wear compared to females and rural population, respectively. Erosion lesions were higher in people consuming alcohol and soft drinks and with the gastric regurgitation compared to their counterparts. Attrition lesions were significantly higher among tobacco chewers and in patients with parafunctional habits such as bruxism compared to their counterparts. Conclusions: This study throws a light on the prevalence of tooth wear in South West Coastal population of India, and its associated risks, which can be utilized for patient education and increasing the awareness regarding tooth wear as timely intervention is vital for arresting irreversible disease process and the well-being of the patient.

A highly transmissible tuberculosis outbreak: the importance of bars.

The transmission of tuberculosis (TB) in bars is difficult to study. The objective was to describe a large TB outbreak in a company's bar and other leisure settings. A descriptive study of a TB outbreak was carried out. Contacts were studied in the index case's workplace bar (five circles of contacts) and other recreational areas (social network of three bars in the index case's neighbourhood). Chest X-rays were recommended to contacts with positive tuberculin skin tests (TST) (⩾5 mm). The risk of latent tuberculosis infection (LTBI) was determined using an adjusted odds ratio. The dose-response relationship was determined using the chi-square test for linear trend. We studied 316 contacts at the index case's workplace and detected five new cases of TB. The prevalence of LTBI was 57·9% (183/316) and was higher in the first circle, 96·0% (24/25), and lower in the fifth, 46·5% (20/43) (P < 0·0001). Among 58 contacts in the three neighbourhood bars, two TB cases were detected and the LTBI prevalence was 51·7% (30/58). Two children of one secondary TB company patient became ill. Bars may be transmission locations for TB and, as they are popular venues for social events, should be considered as potential areas of exposure.

Hepatitis E virus seroprevalence among the general population in a livestock-dense area in the Netherlands: a cross-sectional population-based serological survey

BackgroundRecent serological studies indicate that hepatitis E virus (HEV) is endemic in industrialised countries. The increasing trend in the number of autochthonous cases of HEV genotype 3 in Western European countries, stresses the importance to get insight in the exact routes of exposure. Pigs are the main animal reservoir, and zoonotic food-borne transmission of HEV is proven. However, infected pigs can excrete large amounts of virus via their faeces enabling environmental transmission of HEV to humans. This might pose a risk for of neighbouring residents of livestock farming.MethodsWithin a large study on the health of people living in the vicinity of livestock farming we performed a cross-sectional population-based serological survey among 2,494 non-farming adults from the general population in a livestock-dense area in the south of the Netherlands. Participants completed risk factor questionnaires and blood samples of 2,422 subjects (median age 58 years, range 20–72) were tested for anti-HEV IgG using an enzyme immune assay (Wantai). The aim of this study was to determine the HEV seroprevalence and to assess whether seropositivity in adults was associated with living in the vicinity of pig farms.ResultsThe average seroprevalence of HEV was 28.7% (95% CI: 26.9–30.5). Determinants associated with an increased risk for HEV seropositivity were male gender and low level of education. There was a clear trend of increasing prevalence with increasing age (Chi-square test for linear trend, X2 = 83.1; p < 0.001). A high number of pigs within 1,000 m of the residential address was not a risk factor for seropositivity.ConclusionsThis study confirmed the high HEV seroprevalence (29%) in the general population of the Netherlands, but presence of antibodies was not associated with residential proximity to pig farms. The prevalence increased with age from 10% in adolescents to 33% among those aged 50 and above, supporting the assumption of a cumulative lifetime exposure to HEV in the Netherlands as well as a higher infection pressure in the past. Our findings cannot refute the assumption that transmission is primarily food-borne.

Emergency Dental Care of Children and Adolescents in Basic Health Unit and Emergency Care Unit

Objective: To evaluate the factors related to the dental emergency care of children and adolescents in Basic Health Units (UBS) and Emergency Care Units (UPA) affiliated with the public dental network of Curitiba, Brazil. Material and Methods: Cross-sectional study that evaluated 1,012 emergency cases in individuals aged up to 17 years old and with a permanent record in the Unified Health System of Curitiba. Demographic data of individuals and of services were taken from electronic medical records. Statistical analysis was performed using the chi-square test and chi-square test for linear trend (α = 0.05), estimating the prevalence ratio (PR) (95%CI). Results: Of the total of emergency cases, 68.2% and 31.8% were of children and adolescents, respectively. UBS accounted for 89.7% of the cases while UPA represented 10.3%, and 12.2% of the treatments were characterized as first access to the system. Adolescents used UPAs for emergency care more often than children (PR = 1.84; 95%CI: 1.28-2.64). Among children, those with more than 1 year since the last appointment used UPAs for emergency care more often (PR = 1.86; 95%CI: 1.09-3.17). Adolescents for whom emergency care was characterized as first access to the system used UPAs more often (PR = 2.16; 95%CI: 1.04-4.46). The proximity between the UBS of origin and the UPA was associated with greater UPA utilization by both groups. Conclusion: UBSs accounted for most of the dental emergency treatments. Children and adolescents with a poorer connection with UBSs and those who lived near an UPA had a higher prevalence of UPA utilization for emergency care.

Prevalência e fatores associados à prática de atividades físicas no lazer: inquérito repetido em estudantes universitários

The practice of leisure physical activity represents a behavior that must be monitored in different population groups. The objectives of this study were i) to compare the prevalence of leisure-time physical activity in university students along the survey years in three separate years; ii) to analyze the factors associated with practice of leisure time physical activity in each survey. Three surveys in a college institution in northeastern Brazil in 2010, 2012 and 2014 were carried out. The dependent variable was practice of leisure-time physical activity. Exploratory variables were sociodemographic factors and link with the university. The prevalence was compared using the chi-square test for linear trend and association for Prevalence Ratio. Participation was of 1,084, 1,085 and 1,041 college students in 2010, 2012 and 2014, respectively. The prevalence of leisure-time physical activity was approximately 50% in the three surveys. Women were less active in leisure time on the three surveys. In each survey, associations were different in relation the courses, and Chemistry – teacher training, Computer Science, Pedagogy – teacher training and Linguistics (no specialization) students showed lower levels of leisure-time physical activity and Biomedicine, Geography – Bachelor, Physical Education – teacher training and Geography – teacher training students were more active in leisure time. It was concluded that there was a stabilization of the prevalence of active leisure over time and that women showed lower prevalence of leisure-time physical activity in the three surveys.

Prevalência e fatores associados à prática de atividades físicas no lazer: inquérito repetido em estudantes universitários

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n5p577 The practice of leisure physical activity represents a behavior that must be monitored in different population groups. The objectives of this study were i) to compare the prevalence of leisure-time physical activity in university students along the survey years in three separate years; ii) to analyze the factors associated with practice of leisure time physical activity in each survey. Three surveys in a college institution in northeastern Brazil in 2010, 2012 and 2014 were carried out. The dependent variable was practice of leisure-time physical activity. Exploratory variables were sociodemographic factors and link with the university. The prevalence was compared using the chi-square test for linear trend and association for Prevalence Ratio. Participation was of 1,084, 1,085 and 1,041 college students in 2010, 2012 and 2014, respectively. The prevalence of leisure-time physical activity was approximately 50% in the three surveys. Women were less active in leisure time on the three surveys. In each survey, associations were different in relation the courses, and Chemistry – teacher training, Computer Science, Pedagogy – teacher training and Linguistics (no specialization) students showed lower levels of leisure-time physical activity and Biomedicine, Geography – Bachelor, Physical Education – teacher training and Geography – teacher training students were more active in leisure time. It was concluded that there was a stabilization of the prevalence of active leisure over time and that women showed lower prevalence of leisure-time physical activity in the three surveys.

Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools

Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: < 65 years, 65-80 years, and > 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28.8 and 54.3 % of patients were at risk of malnutrition (MNA 17-23.5), while the fractions of patients already suffering from malnutrition (MNA < 17) were 5.4 and 8.6 %, respectively. The correlation between the NRS and MNA total scores increases with the age of the patients. The correlation coefficient for patients under 65 years is r = - 0.380, while among patients aged between 65 and 80, it is r = - 0.481, and for patients over 80 years, there is a medium to strong correlation of r = - 0.638 (each with a Spearman correlation of p < 0.001). For the total population as well as the different age groups, statistically significant correlations were recorded between the categorised scores (chi-square test for linear trend, p < 0.001). Summary: The present study demonstrates high prevalence of malnutrition among the geriatric trauma patients. Because of its easy and rapid application, the NRS has an advantage in clinical use. It was shown that the two methods of data survey were highly correlated.

The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting.

To evaluate the influence of prostate-specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting. Retrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1-5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013-2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1-0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi-square test for linear trend. Gleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1-2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4-5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001). In a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.

Risk factors for tuberculosis smear non-conversion in Eden district, Western Cape, South Africa, 2007-2013: a retrospective cohort study.

BackgroundTuberculosis (TB) continues to be a major global health problem. While progress has been made to improve TB cure rates, South Africa’s 76 % smear-positive pulmonary TB (PTB) case cure rate remains below the WHO target of 85 %. We report on the trends of TB smear non-conversion and their predictors at the end of an intensive phase of treatment, and how this impacted on treatment outcomes of smear-positive PTB cases in Eden District, Western Cape Province, South Africa.MethodsRoutinely collected, retrospective data of smear-positive PTB cases from the electronic TB register in Eden District between 2007 and 2013 was extracted. Non-conversion was defined as persistent sputum smear-positive PTB cases at the end of the two or three month intensive phase of treatment. Chi-square test for linear trend and simple linear regression analysis were used to analyse the change in percentages and slope of TB smear non-conversion rates over time. Risk factors for TB non-conversion, and their impact on treatment outcomes, were evaluated using logistic regression models.ResultsOf 12,742 total smear-positive PTB cases included in our study, 12.8 % (n = 1627) did not sputum smear convert; 13.3 % (1411 of 10,574) of new cases and 9.9 % (216 of 2168) of re-treatment cases. Although not statistically significant in either new or re-treatment cases, between 2007 and 2013, smear non-conversion decreased from 16.4 to 12.7 % (slope = −0.60; 95 % CI: −1.49 to 0.29; p = 0.142) in new cases, and from 11.3 to 10.8 % in re-treatment cases (slope = −0.29; 95 % CI: −1.06 to 0.48; p = 0.376). Male gender, HIV co-infection and a >2+ acid fast bacilli (AFB) smear grading at the start of TB treatment were independent risk factors for non-conversion (p < 0.001). Age was a risk factor for non-conversion in new cases, but not for re-treatment cases. Non-conversion was also associated with unsuccessful treatment outcomes (p < 0.01), including treatment default and treatment failure.ConclusionsSmear-positive PTB cases, especially men and those with identified risk factors for non-conversion, should be closely monitored throughout their treatment period. The South African TB control program should invest in patient adherence counselling and education to mitigate TB non-conversion risk factors, and to improve conversion and TB cure rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1712-y) contains supplementary material, which is available to authorized users.

Description of the Characteristics of Multiple Sclerosis Patients in the Region of Valencia (Spain) Who Requested Treatment with Disease-Modifying Drugs during the 2005-2014 Decade

Background: More than 3,000 multiple sclerosis (MS) patients were treated with disease-modifying drugs (DMDs) in the Region of Valencia during 2005-2014. We aimed at describing the demographic and clinical characteristics of MS patients who requested treatment with DMDs, variations in their use, and the factors associated with change to second-line therapies during this decade. Methods: A retrospective cohort study with information from Subcomité Especializado de Medicamentos de Alto Impacto Sanitario y/o Económico registers. A statistical analysis was run in 2 phases: descriptive analysis of the sample using classical statistical methods, and of DMD trend by a chi-square test for linear trends; analytic analysis to examine the factors associated with change to second-line treatment (logistic regression model). Results: We selected 2,205 patients (mean age 32.12, SD 9.64; 70% females, and 86.6% remising-remitting MS (RRMS)); 1,012 patients were attended to in highly specialized MS units (45.8%); 525 in monographic units (23.8%); and 668 in general units (30.2%). DMD prescriptions increased, and glatiramer acetate was more widespread at the end of the period (35.4%). Conclusion: Variability in access to different treatments was slight. The younger the patient, the higher the risk of first-line RRMS treatment failing in female gender and first treatment with interferon.

Fatores associados ao tempo de tela em estudantes do ensino médio de Fortaleza, região Nordeste do Brasil

Aims: To investigate the factors associated with the time adolescents spend watching television, using the computer, or playing video games. Methods: Cross-sectional study with adolescents attending high school, randomly selected from four schools of the Liceu do Ceara network in the city of Fortaleza, Northeastern Brazil. The number of students invited to participate in the study was proportional to the representative sample of the school. All the data were self-reported, including: daily screen time (time spent watching television or using the video game or the computer), intake of soft drinks, sweets, and packaged snack foods, sex, age, school shift, occupational status, participation in physical education classes, and practice of extracurricular physical activity. The chi-square test for linear trend was used to assess the associations, and the significance level was set as p <0.05. Results: A total of 964 students (46.4% aged 17 to 19 years and 51.5% female) were assessed. The prevalence of students who watched TV for more than 3 hours a day was 51.1% and the highest rate was observed among younger adolescents of both sexes, who did not work, went to school in the afternoon, and often consumed soft drinks, sweets, and packaged snack foods. Excessive use of computer / video games was observed in 21.85% of the sample, with a higher prevalence among boys who attended school in the morning and regularly consumed packaged snack foods. Conclusions: Sociodemographic and behavioral factors, including eating habits, are associated with screen time among adolescents. However, associated factors differed depending on the most widely type of media used (TV, computer, or video games). These aspects should be considered in programs for the elimination of leisure time sedentary behavior among adolescents.

Impact of Vaccination on Measles Transmission Patterns in Gweru City, Zimbabwe, 1960-89

A study was carried out in Gweru urban district (population-158233) in Zimbabwe to determine the impact of measles vaccine applied at 9 months of age on measles transmission patterns. A retrospective observational study that used data from measles vaccination records and measles disease surveillance was conducted. Linear regression analysis and the chi-squared test for linear trend (χ²) were used to investigate linear relationships at a 5% significance level. Vaccine coverage rates were 0% in pre-vaccination era in 1960-70 and 2-92% in 1971-89 (median=65, Q₁=34, Q₃=88) when they significantly linearly increased (p<0.001). In 1960-85 measles incidence rates significantly linearly increased (p<0.001) while in 1986-89 at vaccine coverage rates of >90% incidence rates significantly linearly declined (p<0.001). Proportion of vaccinated cases among measles notifications significantly linearly increased as vaccine coverage rates increased (Slope: +1.19, 95% CI [0.52, 1.86]). At vaccine coverage rates of >80% (1984-89), proportion of vaccine failures among cases aged 60-119 months was significantly higher than at vaccine coverage rates of <80% (1971-83) (p=0.011) while in age group 10-59 months proportions of vaccine failures were not different at vaccine coverage rates of <80% and >80%. In age group 60-119 months incidence rates significantly linearly increased as vaccine coverage rates increased (Slope: +29.88, 95 CI [13.95, 45.82]). In pre-vaccination era, and at vaccine coverage rates of <80% and >80% some 75% of all reported measles cases occurred by age 36-47 months, 48-59 months and 72-83 months respectively. In conclusion, measles incidence rates declined at vaccine coverage rates of >90%, while measles vaccine failures significantly increased as vaccine coverage rates increased. Increasing measles vaccination coverage led to shift of age at infection from age group <59 months to age group 60-119 months and decline in rates of measles transmission.

Decision support systems in clinical practice: The case of venous thromboembolism prevention.

Decision support systems in clinical practice: The case of venous thromboembolism prevention.

Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial.

The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy. One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend. Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture. The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.