Epidemiological studies are like cherries, one draws another

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

Dementia and cognitive impairment: Burden of disease and risk factors

Dementia is the most common form of neurodegenerative condition and is increasingly frequent as world population ages. It is a leading cause of death and is responsible for considerable morbidity, expressed in the high levels of functional dependence and institutionalization. From a resource management and prevention point of view, it becomes crucial to better characterize the epidemiology of this entity, namely its geographic distribution, its risk factors and impact at a population level. The fact that there are at present no disease-modifying treatments justifies an investment in the identification of modifiable risk factors that may be contemplated in prevention strategies. Recent epidemiological studies increasingly recognize an association between vascular risk factors and cognitive deterioration. © ArquiMed, 2010

Global trends in Kaposi sarcoma incidence and mortality: the need for action to reduce inequalities

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Dementia and cognitive impairment: Clinical diagnosis and classification

Dementia is an increasingly prevalent chronic condition, with a profound social impact. In the last few decades, emerging basic science concepts revealed the existence of various forms of dementia, with distinct neuropathological mechanisms. The two most representative subtypes of dementia in individuals over 65 years old are Alzheimer's Disease and Vascular Dementia, with an increasingly recognized phenotypic overlap between these two entities. Mild Cognitive Impairment is an evolving operational concept, aiming to describe a transitional state between normal aging processes and dementia. Its relevance is nowadays undisputed, both at the clinical and scientific research level. The diagnosis of both Dementia and Mild Cognitive Impairment are for the time being limited to clinical features and supportive auxiliary test results, which stresses the need for a thorough neuropsychological and neuropsychiatric assessment. © AcquriMed 2011

Epidemiologia do cancro do colo Do útero

Cervical cancer is the fifth most common cancer in European women. The recognition of a viral agent such as Human Papillomavirus (HPV) as a necessary cause in the development of cervical cancer implies that this disease may be prevented by effective prophylactic or therapeutic interventions against this infection. HPV vaccines conferring protection against infection with oncogenic HPV types 16 and 18, which cause the majority of the cervical cancer cases, are currently marketed, but. continued cervical cancer screening is necessary regardless of vaccination. Organised screening programs have the highest potential to reduce cervical cancer mortality, by achieving higher levels of coverage of all population groups and higher proportions of women screened at regular intervals, with better costeffectiveness and overall quality. Opportunistic screening, on the other hand, has a more limited impact and is more difficult to monitor and to evaluate due to its decentralized nature and lack of systematic reporting. However, opportunistic screening is still predominant in most European countries. In Portugal, cervical cancer screening has been predominantly opportunistic, except for regional organised programs in the Central Region of Portugal, in the region of Alentejo and an organised screening program is also being implemented in the North region of Portugal

Modifiable factors and esophageal cancer: a systematic review of published meta-analyses.

There are marked differences in the etiology of the major histological types of esophageal cancer (EC)—squamous cell carcinomas (ESCC) and adenocarcinomas (EAC). This study aimed to summarize the current scientific knowledge on modifiable risk factors for EC, by histological type, through a systematic review of meta-analyses referenced in PubMed and ISI Web of Knowledge. We identified 100 meta-analyses on risk factors for ESCC (n = 54), EAC (n = 43), or EC (n = 51). ESCC risk significantly increased with alcohol and maté drinking, smoking, red and processed meat consumption and human papillomavirus infection, while it was negatively associated with body mass index and consumption of fruit, vegetables, white meat, folate, and some carotenoids. Cessation of drinking and smoking significantly reduced ESCC risk. For EAC, an increased risk was reported for smoking, body mass index, and red and processed meat consumption, while risk decreased with Helicobacter pylori infection, low/moderate alcohol drinking, physical activity, and consumption of fruit, vegetables, folate, fiber, beta-carotene, and vitamin C. Differences in results between meta-analyses and mechanisms underlying some of the associations found are discussed. This work reinforces the importance of a separate assessment of EC subtypes to allow for a proper evaluation of incidence trends and planning of prevention/control interventions.This work was supported by FEDER funds through the Operational Competitiveness Programme and by national funding from the Foundation for Science and Technology–FCT (Portuguese Ministry of Science, Technology and Higher Education) (FCOMP-01-0124-FEDER-021181), under the project “Determinants of gastric and esophageal cancers incidence in the north of Portugal” (PTDC/SAU-EPI/122460/2010), and the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; UID/DTP/04750/2013). An individual Postdoc grant attributed to BP (SFRH/BPD/75918/2011) was co-funded by the FCT and the "Programa Operacional Capital Humano" (POCH/FSE)

Cumulative incidence estimates in the presence of competing risks

This study was funded by FEDER through the Operational Program Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). An individual PhD grant attributed to S.M. (SFRH/BD/102585/2014) was funded by FCT and the “Programa Operacional Capital Humano” (POCH/FSE). The funding sources had no involvement in the conduct of the research and/or preparation of the commentary

Effect of questionnaire structure on recall of drug utilization in a population of university students

Background. Self-reported data are a common source of information about drug exposure. Modes of data collection differ considerably and the questionnaire's structure may affect prevalence estimates. We compared the recall of medication use evaluated by means of two questionnaires differing in structure and length. Methods. Drug utilization was assessed by two alternative versions of a questionnaire (A 4 pages, including specific questions for 12 indications/pharmacological groups and one question for "other medicines"; B 1 page, including 1 open-ended question to cover overall drug consumption). Each of 32 classes in a private University in Maputo, Mozambique, was randomly assigned questionnaire A (233 participants) or B (276 participants). Logistic regression (allowing for clustering by classroom) was used to compare the two groups in terms of socio-demographic characteristics and medication used during the previous month. Results. Overall, 67.4% of the subjects had used at least one drug during the previous month. The following prevalences were greater among participants completing questionnaire A: use of drugs from two or more pharmacological groups (60.5% vs. 34.4%, p < 0.001), use of two or more drugs (66.2% vs. 43.0%, p < 0.001), and use of antibiotics (14.6% vs. 6.9%, p = 0.001), antifungals (9.4% vs. 4.0%, p = 0.013), antiparasitics (5.6% vs. 1.8%, p = 0.031) and antacids (8.6% vs. 3.6%, p = 0.024). Information about duration of treatment and medical advice was more complete with version A. Conclusion. The indication/drug-specific questions (questionnaire A) revealed a significantly higher prevalence of use of medicines antibiotics, antifungals, antiparasitics and antacids without compromising the completeness of the information. © 2009 Gama et al

Risk of second primary cancers among patients with a first primary gastric cancer: A population-based study in North Portugal

Background: The growing number of incident cases of gastric cancer along with improved survival result in a rising population of survivors at risk of second primary cancers (SPC). We estimated the cumulative incidence of metachronous (diagnosed >2 months after first primary cancer [FPC]) SPC in gastric FPC patients and compared the incidence of metachronous SPC with that expected in the general population. Methods: A cohort of gastric FPC patients from the North Region Cancer Registry of Portugal, diagnosed in 2000–2006 (n = 7427) was followed to 31 December 2010 for synchronous and metachronous SPCs. Cumulative incidence of metachronous SPCs taking into account death as a competing event and standardized incidence ratios (SIR) of metachronous SPCs were estimated. Results: Overall, 331 (4.5%) patients developed an SPC (26.9% synchronous and 73.1% metachronous). Over half of the SPCs occurred in digestive organs. Among men, the most frequent were colon, prostate, and trachea, bronchus and lung; in women, colon, breast and thyroid were the most common. The 10-year cumulative incidence of metachronous SPC for males was 5.7% and for females 3.5%. The SIR for all cancers was 1.30 in males and 1.20 in females. Among both sexes, significantly higher SIRs were observed for cancers of the oesophagus (males: 4.99; females: 8.03), small intestine (males: 11.04; females: 13.09) and colon (males: 2.42; females: 2.58). Conclusions: Patients with a gastric FPC were found to be at increased risk of developing SPC, mainly in digestive organs, when compared to the general population. Close surveillance of these patients may allow early detection of SPC.This study was funded by FEDER (European Regional Development Fund) through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology − FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia − Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). An individual PhD grant attributed to SM (SFRH/BD/102585/2014) was funded by FCT and the “Programa Operacional Capital Humano” (POCH/FSE)