Regressão logística politômica nominal e ordinal

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Comparação do "odds ratio" generalizado com os parâmetros de regressão logística politômica

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Net survival in survival analyses for patients with cancer : a scoping review

Population-based net survival is an important tool for assessing prognostic advances. The unbiased Pohar Perme Estimator (PPE) was suggested in 2012 and soon established itself as the gold standard for estimating net survival. This scoping review aims to know in which context this estimator is being used in the oncology area, what the authors point out as a justification for its use, and the limitations found. We searched PubMed, and the grey literature to answer the question: Have studies involving patients diagnosed with cancer used the PPE to estimate cancer-specific survival? How do they justify the use of the PPE and what are the limitations pointed out? Out of 295 screened, 85 studies were included in this review. The two main characteristics of the PPE mentioned by the studies as justification were the fact that it is an unbiased estimator (83.5%) and that it produces comparable estimates among populations with different mortality rates from causes other than cancer (36.47%). No study pointed to a limitation due to the use of PPE. As a conclusion, the Pohar Perme Estimator is the gold standard for estimating net survival and should be more used in oncology, especially when dealing with population-based studies where the follow-up time is long, making high the probability of death from causes other than cancer

Atención sanitaria fronteriza y pronóstico de infección por VIH en la triple frontera Brasil-Paraguay-Argentina

O ato de atravessar uma fronteira internacional para receber cuidados de saúde é uma realidade nas áreas fronteiriças. O fluxo tende a ser em direção à cidade com os melhores recursos humanos e melhor infraestrutura em saúde. Embora sejam conhecidos os fatores prognósticos relacionados à infecção pelo HIV, o valor prognóstico desse tipo de migração a longo prazo tem recebido menos atenção. Este estudo divide e compara o prognóstico em três grupos de pacientes com HIV: um envolvido em mobilidade regional, outro em mobilidade transfronteira em busca de assistência e o terceiro constituído de pacientes que residem na mesma cidade onde o serviço de saúde está localizado. Este estudo de coorte retrospectiva utiliza dados de prontuários de um serviço de saúde no Brasil. Ao analisar a sobrevida com o teste de log-rank e modelos riscos proporcionais de Cox, a sobrevida geral não mostrou diferença significativa entre pacientes que recebiam cuidados através da mobilidade regional (HR = 1,03; IC95%: 0,69-1,54; p = 0,89) ou transfronteira (HR = 1,07; IC95%: 0,58-1,97; p = 0,83) e aqueles que recebiam atendimento na cidade onde residiam. Essa falta de diferença se manteve quando a análise foi ajustada para os fatores prognósticos conhecidos. Neste estudo de coorte retrospectiva, a exposição à migração regional ou internacional não mostrou associação significativa com o risco de óbito por qualquer causa, de acordo com a análise bruta e as análises ajustadas para os fatores prognósticos já conhecidos. Este foi o primeiro estudo a considerar o papel prognóstico da assistência transfronteira para pacientes com HIV. Apesar desses achados, enfatiza-se a necessidade de monitorar o grau e as características clínicas e demográficas da demanda por assistência com origem do lado oposto da fronteira, além de utilizar esses dados no processo decisório na gestão da saúde.The act of crossing an international border for healthcare is a reality in border areas and the flow is in the direction of the city with more human and healthcare resources. Although several prognostic factors related to HIV+ patients are known, the prognostic value of this type of mobility for long term care is still neglected. This study compares the prognosis of HIV patients from three groups, one involved in regional mobility, another in cross-border mobility in search for healthcare and the reference group which is composed by patients living in the same city of the health facility. This is a retrospective cohort study using medical records from a healthcare service in Brazil. Following survival analysis with log-rank test and Cox proportional hazard models, overall survival had no significant difference between patients who were involved in regional (HR = 1.03; 95%CI: 0.69-1.54; p = 0.89) or international (HR = 1.07; 95%CI: 0.58-1.97; p = 0.83) mobility and those who were not. This lack of difference was kept when adjusted for known prognostic factors. In this retrospective cohort study, exposure to both regional and international migration did not have a significant association with the risk of death by any cause in crude or adjusted analyses for already known prognostic factors. This is the first study to consider the prognostic role of cross-border healthcare for HIV patients. Despite these findings, the need of monitoring the extent and the clinical and demographic characteristics of healthcare demand originated in the other side of the border and the use of these data for decision making in health management is emphasized.El hecho de cruzar una frontera internacional en búsqueda de asistencia sanitaria es una realidad en las áreas fronterizas y el flujo migratorio se dirige hacia la ciudad con más recursos humanos y sanitarios. A pesar de que se conocen los diferentes factores pronósticos relacionados con el VIH, el valor pronóstico de este tipo de movilidad continúa todavía olvidado durante mucho tiempo. Este estudio compara los pronósticos de pacientes de VIH de tres grupos, uno implicado en la movilidad regional, otro en la movilidad fronteriza en búsqueda de asistencia sanitaria y el grupo de referencia que estaba compuesto por pacientes viviendo en la misma ciudad donde se encontraban los servicios sanitarios. Este es un estudio retrospectivo de cohorte, usando expedientes médicos de un servicio de salud en Brasil. En los siguientes análisis de supervivencia con prueba log-rank y modelos de Cox de riesgo proporcional, en cuanto a la supervivencia general no hubo una diferencia significativa entre pacientes que estaban implicados en la movilidad regional (HR = 1,03; 95%CI: 0,69-1,54; p = 0,89) o internacional (HR = 1,07; 95%CI: 0,58-1,97; p = 0,83) y aquellos que no lo estuvieron. Esta falta de diferencia se mantuvo cuando se ajustó para los factores pronósticos conocidos. En este estudio retrospectivo de cohorte, la exposición tanto a la migración regional como la internacional no tuvo una asociación significativa con el riesgo de muerte por alguna causa en los análisis crudos o ajustados para los factores pronósticos ya conocidos. Se trata del primer estudio en considerar el papel pronóstico de la asistencia sanitaria transfronteriza en pacientes con VIH. A pesar de estos resultados, existe la necesidad de un monitoreo sobre la extensión y las características clínicas y demográficas de la demanda de servicios sanitarios al otro lado de la frontera, así como el énfasis del uso de estos datos para l

Splenic flexure mobilization in sigmoid and rectal cancer resections : a meta-analysis of surgical outcomes

Objetivo: avaliar a influência da mobilização da flexura esplênica nos principais resultados cirúrgicos de pacientes submetidos à ressecção de câncer do cólon sigmoide ou reto. Métodos: os bancos de dados MEDLINE, Cochrane Central Register de Ensaios Controlados e LILACS foram pesquisados usando os termos "mobilização da flexura esplênica", "cirurgia colorretal", "câncer retal", "ressecção anterior", "câncer de cólon sigmoide", "ressecção de sigmoide". O desfecho principal foi a deiscência da anastomose. Outros desfechos analisados foram mortalidade, sangramento, infecção e complicações gerais. Os tamanhos dos efeitos foram estimados por meio do agrupamento dos dados de seis estudos de caso-controle (1.433 pacientes) publicados até janeiro de 2018. Resultados: nossa meta-análise revelou que pacientes submetidos à mobilização completa da flexura esplênica tinham um risco maior de deiscência anastomótica (RR=2,27, IC95%: 1,22-4,23) em comparação àqueles não submetidos a esse procedimento. Nenhuma diferença pôde ser demonstrada entre os grupos em termos de mortalidade, sangramento, infecção e complicações gerais. Conclusão: a mobilização da flexura esplênica está associada a um maior risco de deiscência anastomótica nas ressecções de câncer de reto ou cólon sigmoide. Esta manobra cirúrgica deve ser utilizada com cautela no manejo cirúrgico dos tumores colorretais.Objective: to evaluate the influence of the splenic flexure mobilization for the main surgical outcomes of patients submitted to resection of sigmoid and rectal cancer. Methods: we searched the MEDLINE, Cochrane Central Register of Controlled Trials and LILACS, using the terms "splenic flexure mobilization", "colorectal surgery", "rectal cancer", "anterior resection", "sigmoid colon cancer", and "sigmoid resection". The main outcome was anastomotic dehiscence. Other outcomes analyzed were mortality, bleeding, infection and general complications. We estimated the effect sizes by grouping data from six case-control studies (1,433 patients) published until January 2018. Results: our meta-analysis showed that patients undergoing complete mobilization of the splenic flexure had a higher risk of anastomotic dehiscence (RR=2.27, 95%CI: 1.22-4.23) compared with those not submitted to this procedure. There was no difference between the groups in terms of mortality, bleeding, infection and general complications. Conclusion: splenic flexure mobilization is associated with a higher risk of anastomotic dehiscence in resections of sigmoid and rectal cancer. This surgical maneuver should be used with caution in the surgical management of sigmoid or rectal cancers

Association between PCOS and autoimmune thyroid disease : systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder affecting women of reproductive age. PCOS has been associated with distinct metabolic and cardiovascular diseases and with autoimmune conditions, predominantly autoimmune thyroid disease (AITD). AITD has been reported in 18–40% of PCOS women, depending on PCOS diagnostic criteria and ethnicity. The aim of this systematic review and metaanalysis was to summarize the available evidence regarding the likelihood of women with PCOS also having AITD in comparison to a reference group of non-PCOS women. We systematically searched EMBASE and MEDLINE for non-interventional case control, cross-sectional or cohort studies published until August 2017. The Ottawa–Newcastle Scale was used to assess the methodological quality of studies. Statistical meta-analysis was performed with R. Thirteen studies were selected for the present analysis, including 1210 women diagnosed with PCOS and 987 healthy controls. AITD was observed in 26.03 and 9.72% of PCOS and control groups respectively. A significant association was detected between PCOS and chance of AITD (OR = 3.27, 95% CI 2.32–4.63). Notably, after geographical stratification, the higher risk of AITD in PCOS women persisted for Asians (OR = 4.56, 95% CI 2.47–8.43), Europeans (OR = 3.27, 95% CI 2.07–5.15) and South Americans (OR = 1.86, 95% CI 1.05–3.29). AIDT is a frequent condition in PCOS patients and might affect thyroid function. Thus, screening for thyroid function and thyroidspecific autoantibodies should be considered in patients with PCOS even in the absence of overt symptoms. This systematic review and meta-analysis is registered in PROSPERO under number CRD42017079676

Predictors of in-hospital mortality among patients with pulmonary tuberculosis : a systematic review and meta-analysis

Background: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. Methods: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for inhospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). Results: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01–3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40–2.48), or male sex (OR 1.09, 95% CI 0.84–1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38–4.46), and previous TB infection (OR 2.66, 95% CI 0.48–14.87). Conclusion: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients

Factors associated with women’s satisfaction with prenatal care in Porto Alegre, Rio Grande do Sul, Brazil

O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08- 2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12- 2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction