Multilevel survival analysis of health inequalities in life expectancy

<p>Abstract</p> <p>Background</p> <p>The health status of individuals is determined by multiple factors operating at both micro and macro levels and the interactive effects of them. Measures of health inequalities should reflect such determinants explicitly through sources of levels and combining mean differences at group levels and the variation of individuals, for the benefits of decision making and intervention planning. Measures derived recently from marginal models such as beta-binomial and frailty survival, address this issue to some extent, but are limited in handling data with complex structures. Beta-binomial models were also limited in relation to measuring inequalities of life expectancy (LE) directly.</p> <p>Methods</p> <p>We propose a multilevel survival model analysis that estimates life expectancy based on survival time with censored data. The model explicitly disentangles total health inequalities in terms of variance components of life expectancy compared to the source of variation at the level of individuals in households and parishes and so on, and estimates group differences of inequalities at the same time. Adjusted distributions of life expectancy by gender and by household socioeconomic level are calculated. Relative and absolute health inequality indices are derived based on model estimates. The model based analysis is illustrated on a large Swedish cohort of 22,680 men and 26,474 women aged 6569 in 1970 and followed up for 30 years. Model based inequality measures are compared to the conventional calculations.</p> <p>Results</p> <p>Much variation of life expectancy is observed at individual and household levels. Contextual effects at Parish and Municipality level are negligible. Women have longer life expectancy than men and lower inequality. There is marked inequality by the level of household socioeconomic status measured by the median life expectancy in each socio-economic group and the variation in life expectancy within each group.</p> <p>Conclusion</p> <p>Multilevel survival models are flexible and efficient tools in studying health inequalities of life expectancy or survival time data with a geographic structure of more than 2 levels. They are complementary to conventional methods and override some limitations of marginal models. Future research on determinants of health inequalities in the LE of the specific cohort on the household and individual factors could reveal some important causes over the marked household level inequalities.</p

Análise acústica da fala suavizada: estudo de caso em gagueira

A suavização é uma estratégia utilizada no tratamento comportamental da gagueira. A estratégia reduz a frequência da gagueira, mas também modifica a prosódia da fala. O objetivo desta pesquisa é comparar diversos parâmetros acústicos da fala suavizada em relação à fala habitual. Para tanto, foi realizado um estudo de caso. O sujeito da pesquisa foi um homem adulto, falante nativo do português brasileiro, com gagueira desde a infância. Ele leu frases-veículo que continham palavras-chave. Ao todo, foram utilizadas 21 palavras-chave: cada uma iniciando com uma das três plosivas não-vozeadas [p, t, k], seguidas por uma das sete vogais orais do português brasileiro [a, eh, e, i, oh, o, u]. As palavras-chave foram do tipo [‘CVCV]. Todas as frases foram lidas cinco vezes com a forma habitual e suavizada de fala. Os resultados indicaram que a frequência da gagueira diminuiu com a fala suavizada (p < 0,001). A fase de oclusão das plosivas, as palavras-chave e as frases apresentaram duração reduzida (p < 0,001), enquanto a fase de soltura das plosivas e o tempo de início do vozeamento apresentaram duração aumentada (p < 0,001) na fala suavizada em relação à fala habitual. Esses achados sugerem que a fala suavizada é um modo hipoarticulado de fala. Também houve diminuição da frequência fundamental das vogais e das palavras-chave (p < 0,001), indicando que a fala suavizada é aplicada em nível glótico. Não houve modificações nos três primeiros formantes das vogais, indicando que a fala suavizada não altera a precisão articulatória. Também houve redução da inclinação espectral das sentenças (p < 0,001), sugerindo que a fala suavizada aumenta a energia sonora em altas frequências. Portanto, a suavização não apenas reduz o número de hesitações gaguejadas, mas também modifica significativamente a prosódia da fala

Séries temporais de pausas e de hesitações na fala espontânea

O objetivo deste estudo é examinar a dinâmica de longo prazo de pausas e hesitações na fala espontânea. Foram analisados 20 textos falados, produzidos por adultos sem distúrbios de comunicação. Os dados foram transcritos e segmentados de acordo com os fenômenos de interesse. Posteriormente, os dados foram transformados em sequências numéricas de “zeros” e “uns” e amostrados a cada 200 ms para a geração das séries temporais. Foram utilizados procedimentos estatísticos específicos de séries temporais para análise dos dados. Os resultados apontaram que pausas e hesitações ocorreram de forma estacionária do início ao fim dos textos falados, ou seja, não se acumularam no início, no meio ou no final dos textos. Pausas e hesitações se distribuíram de forma cíclica e periódica ao longo do tempo: os ciclos de pausa apresentaram média de 9 s e os de hesitação, média de 13 s. Pausas e hesitações atuaram em conjunto para a manutenção da fluência, tendo em vista que mudanças de estado em uma série imediatamente geraram mudanças de estado na outra série temporal. Houve poucas ocorrências de ciclos sincronizados de pausas e hesitações e, quando isso ocorreu, os fenômenos geralmente estavam em oposição de fase, ou seja, regiões com maior concentração de pausas ocorreram com regiões de menor concentração de hesitações. Portanto, a estacionaridade e a periodicidade podem ser consideradas modos robustos e estáveis de organização temporal das pausas e hesitações na fala espontânea

What speech-language pathologists and students of speech-pathology understand as fluency and disfluency

PURPOSE: to check the understanding of current students (those who are in 3rd and 4th year) and Speech-Language Pathology professionals about the concepts of fluency and dysfluency, the components and aspects that affect fluency and the sorts of speech dysfluency. METHODS: 107 questionnaires were applied in a sample of 57 professionals and 50 students of Speech-Language Pathology. Qualitative and quantitative analyses were applied to open questions and quantitative analysis was applied to multiple-choice questions. RESULTS: more than 20 analytic factors were identified for each open answer, but no factor was mentioned by the great majority of subjects. Most cited fluency component was speech rate. Psychological factors such as anxiety and introversion-extraversion are among the more quoted factors that affect fluency level. The three sorts of dysfluency which were more categorized as stuttered were blocks, initial prolongations and defense behaviors. There were not significant statistical differences between students' and professionals' answers. Increase in professional practice has changed some answers. CONCLUSION: the subjects: 1) have revealed an ideal concept of fluency (speech free from disruptions), 2) have considered dysfluency as some kind of disorder and not as a speech inherent event, 3) have considered speech rate, not dysfluency, as fluency's most important component, 4) have considered psychological factors, mainly anxiety, as the factors that have the major impact on fluency level (language, cognitive and genetic factors would have a secondary importance) and 5) have classified dysfluency according to scientific literature.OBJETIVO: verificar a compreensão dos estudantes de 3º e 4º anos e dos profissionais de Fonoaudiologia em relação aos conceitos de fluência e disfluência, aos componentes e influenciadores da fluência e aos tipos de disfluências. MÉTODOS: foram aplicados 107 questionários a uma amostra de 57 profissionais e 50 estudantes. Foi realizada análise qualitativo-quantitativa das questões abertas e quantitativa das questões fechadas. RESULTADOS: a análise descritiva identificou mais de 20 fatores para as perguntas abertas (conceito de fluência e de disfluência e componentes da fluência), mas nenhum fator citado pela maioria dos sujeitos. O componente da fluência mais listado relaciona-se à taxa de elocução. Fatores psicológicos como ansiedade e introversão-extroversão estão entre os fatores mais citados como influenciadores do grau de fluência. Os tipos de disfluências mais categorizadas como gaguejadas foram bloqueios, prolongamentos iniciais e comportamentos de defesa. Não houve diferença estatisticamente significante entre profissionais e estudantes quanto ao perfil de respostas. O aumento dos anos de atuação modificou algumas respostas. CONCLUSÃO: os participantes: 1) apresentaram conceito idealizado de fluência (fala livre de rupturas), 2) consideraram disfluência como sinal de alteração e não como um fenômeno intrínseco da fala, 3) consideraram a taxa de elocução, e não as disfluências, como o componente que mais afeta o grau de fluência, 4) consideraram os fatores afetivos, principalmente a ansiedade, como os que mais influenciam o grau de fluência, atribuindo uma influência secundária a fatores lingüísticos, cognitivos e genéticos e 5) classificaram os tipos de disfluências de maneira alinhada com a literatura.Biofono Clínicia de FonoaudiologiaInstituto Brasileiro de FluênciaUniversidade Católica de São PauloUniversidade Estadual de CampinasUniversidade Federal de São Paulo (UNIFESP) Setor de Investigação em Doenças NeuromuscularesUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Setor de Investigação em Doenças NeuromuscularesUNIFESPSciEL

Application of metal complexes as biomimetic catalysts on glycerol oxidation

Two biomimetic complexes were evaluated as catalysts in the H2O2 mediated oxidation of glycerol, namely a peroxidase mimetic Fe(III) protoporphyrin complex (hematin) and the superoxide-dismutase mimetic complex of Mn(III) with 1,3-bis(5-sulphonatesalycilidenamino) propane (MnL−). Catalysis was targeted to glyceraldehyde since antimicrobial power was proved for it. Glyceraldehyde evolved at a higher rate than the uncatalyzed reaction only with hematin acid treated solutions and kinetics were typical of a radical mechanism. Nonetheless, glycerol conversions were low. H2O2 bleached hematin and the immobilization on a porous matrix could not prevent this. Meanwhile, the catalatic activity of hematin was high but its peroxidatic activity was inhibited at pH > 8. Thus, the coordination of hematin compound I to H2O2 over glycerol may be the preferred route with the accumulation of peroxy radicals, able to degrade the porphyrinic ring -with probable iron releasing- but also contributing to glycerol oxidation. On the other hand, a prompt decay with time of the catalatic and peroxidatic activities of MnL− was observed, which was improved by the addition of dimethylsulfoxide (DMSO), dimethylformamide (DMF) or acetone to the basic buffer system. Finally, EPR spectroscopy of MnL− supported the hypothesis of the formation of an inactive bis-oxo-bridged Mn(IV)Mn(IV) dimer upon addition of H2O2.publishedVersionFil: Parodi, Adrián Rodrigo. Universidad Nacional de Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA); Argentina.Fil: Parodi, Adrián Rodrigo. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA); Argentina.Fil: Merlo, Carolina. Universidad Nacional de Córdoba. Instituto Multidisciplinario de Biología Vegetal (IMBIV); Argentina.Fil: Merlo Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Instituto Multidisciplinario de Biología Vegetal (IMBIV); Argentina.Fil: Córdoba, Agostina. Universidad Tecnológica Nacional - Facultad Regional Córdoba (U.T.N – F.R.C). Centro de Investigación y Tecnología Química “Prof. Dr. Oscar A. Orio” (CITeQ); Argentina.Fil: Córdoba, Agostina. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Centro de Investigación y Tecnología Química “Prof. Dr. Oscar A. Orio” (CITeQ); Argentina.Fil: Palopoli, Claudia. Universidad Nacional de Rosario. Instituto de Química Rosario (IQUIR); Argentina.Fil: Palopoli, Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Centro Científico Tecnológico (CCT Rosario). Instituto de Química Rosario (IQUIR); Argentina.Fil: Ferreyra, Joaquín. Universidad Nacional de Rosario. Instituto de Química Rosario (IQUIR); Argentina.Fil: Ferreyra, Joaquín. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Centro Científico Tecnológico (CCT Rosario). Instituto de Química Rosario (IQUIR); Argentina.Fil: Signorella, Sandra. Universidad Nacional de Rosario. Instituto de Química Rosario (IQUIR); Argentina.Fil: Signorella, Sandra. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Centro Científico Tecnológico (CCT Rosario). Instituto de Química Rosario (IQUIR); Argentina.Fil: Ferreira, María Luján. Universidad Nacional del Sur (UNS). Planta Piloto de Ingeniería Química (PLAPIQUI); Argentina.Fil: Ferreira, María Luján. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Planta Piloto de Ingeniería Química (PLAPIQUI); Argentina.Fil: Magario, Ivana. Universidad Nacional de Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA); Argentina.Fil: Magario, Ivana. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA); Argentina

Prólogo

El libro “Vejeces y géneros. Memorias de resistencia, luchas y conquistas colectivas” resulta una marca, un hito en las producciones académicas del campo gerontológico. Nos atrevemos a decir que constituirá un material de consulta para investigadores, profesionales, estudiantes, docentes y a quien le interese ahondar en lecturas sobre el cruce entre trayectorias vitales, narrativas situadas, vejeces e historia.Facultad de Trabajo Socia

Shift Work Is Not Associated with High Blood Pressure or Prevalence of Hypertension

Background: Working mostly at night has been suggested to be associated with upset of chronobiological rhythms and high blood pressure, but the evidence from epidemiological studies is weak. Methods: In a cross-sectional survey, we evaluated the association between shift work and blood pressure, pre-hypertension and hypertension. In total, 493 nurses, nurse technicians and assistants, were selected at random in a large general hospital setting. Hypertension was diagnosed by the mean of four automatic blood pressure readings $140/ 90 mmHg or use of blood pressure lowering agents, and pre-hypertension by systolic blood pressure$120–139 or diastolic blood pressure $80–89 mmHg. Risk factors for hypertension were evaluated by a standardized questionnaire and anthropometric measurements. The association between the shift of work and blood pressure, pre-hypertension and hypertension was explored using univariate and multivariate analyses that controlled for risk factors for hypertension by covariance analysis and modified Poisson regression. Results: The mean age of the participants was 34.369.4 years and 88.2 % were women. Night shift workers were older, more frequently married or divorced, and less educated. The prevalence of hypertension in the whole sample was 16%, and 28% had pre-hypertension. Blood pressure (after adjustment for confounding) was not different in day and night shift workers. The prevalence of hypertension and pre-hypertension by shift work was not different in the univariate analysis and afte

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Background - Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods - Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results - Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions - Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London