Assessment of clinical trial quality and its impact on meta-analyses

OBJECTIVE: To evaluate whether different quality assessment tools applied to a group of clinical trials could be correlated, and what would be their impact on meta-analysis results. METHODS: Thirty-eight randomized controlled clinical trials were analyzed. These had been selected for a systematic review of the therapeutic efficacy of alpha interferon for treating chronic hepatitis B. The following tools were utilized: Maastricht (M), Delphi (D), Jadad (J) and the Cochrane Collaboration (CC) method (gold standard). The Spearman correlation coefficient was used to compare the results from the three methods. The Kappa test was used to assess the concordance between the reviewers in applying the tools, and the weighted Kappa test was applied to compare the quality ranking determined by the tools. The outcomes assessed in the meta-analyses were clearance of HBV-DNA and HBeAg. RESULTS: The studies presented regular to low quality. The concordance between reviewers varied according to the instrument utilized: D=0.12; J=0.29; M=0.33; and CC=0.53. The correlation was moderate and homogeneous (D/J=0.51; D/M=0.53; and J/M=0.52). Thje meta-analysis result relating to HBV-DNA ranged from RR=0.71 (95% CI: 0.66-0.77) to RR=0.67 (95% CI: 0.58-0.79). For HBeAg, the results ranged from RR=0.85 (95% CI: 0.80-0.90) to RR=0.85 ( 95% CI: 0.77-0.93). These results depended on the quality of the studies included. CONCLUSIONS: The quality assessment tools presented good correlation. In systematic reviews with the same direction of effect, the quality assessment may not significantly change the results. The Cochrane Collaboration method was the most reproducible method and easiest to apply.OBJETIVO: Analisar se diferentes instrumentos de avaliação de qualidade, aplicados a um grupo de estudos clínicos que se correlacionam e qual seu impacto no resultado na metanálise. MÉTODOS: Foram analisados 38 estudos clínicos randomizados e controlados, selecionados para a revisão sistemática sobre a eficácia terapêutica do Interferon Alfa no tratamento da hepatite crônica pelo vírus B. Utilizaram-se os seguintes instrumentos: Maastricht (M), Delphi (D) e Jadad (J) e o método da Colaboração Cochrane (CC), considerado padrão-ouro. Os resultados definidos pelos três instrumentos foram comparados pelo teste de Correlação de Spearman. O teste de Kappa (K) avaliou a concordância entre os revisores na aplicação dos instrumentos e o teste de Kappa ponderado analisou o ordenamento de qualidade definido pelos instrumentos. O clareamento do HBV-DNA e HbeAg foi o desfecho avaliado na metanálise. RESULTADOS: Os estudos foram de regular e baixa qualidade. A concordância entre os revisores foi, de acordo com o instrumento: D=0.12, J=0.29 e M=0.33 e CC= 0,53. A correlação foi moderada e homogênea (D/J=0,51; D/M=0,53 e J/M=0,52). Os resultados da metanálise (HBV-DNA), variaram de RR=0,71; IC 95%: 0,66-0,77 a RR=0,67; IC 95%: 0,58-0,79 e (HbeAg) de RR=0,85; IC 95%: 0,80-0,90 a RR=0,85; IC 95%:0,77-0,93, dependendo da qualidade dos estudos incluídos. CONCLUSÕES: Os instrumentos de avaliação de qualidade têm boa correlação. Nas revisões sistemáticas que apontem à mesma direção do efeito, a avaliação pode não alterar significantemente seu resultado. O método da Colaboração Cochrane é o mais reprodutível e de simples aplicação.Faculdade Estadual de Medicina de MaríliaUniversidade Federal do Rio Grande do NorteUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

QUALIDADE RECREACIONAL DAS PRAIAS DA APA LAGOA ENCANTADA/RIO ALMADA, LITORAL SUL DO ESTADO DA BAHIA

Esta pesquisa tem como principal objetivo avaliar a qualidade recreacional das praias da APA Lagoa Encantada/Rio Almada, através de indicadores geoambientais e de infraestrutura. O litoral estudado apresenta aproximadamente 34 km de praias, inseridas nos municípios de Ilhéus e Uruçuca,e representa uma importante área para o crescimento e desenvolvimento turístico do estado da Bahia. As praias Pé de Serra, Sargi, Ponta do Ramo, Luzimares, Ilhéus, Coqueiros, Mamoã, Ponta da Tulha, Verdes Mares, Barramares, Paraíso do Atlântico, Jóia do Atlântico, Mar e Sol, Japará, Fazenda de Osmar, São Domingos e São Miguel foram classificadas a partir de vinte e três indicadores de qualidade geoambiental e onze indicadores de infraestrutura. Estes indicadores foram ponderados em seu grau de importância, de acordo com a preferência dos usuários, através da aplicação de 500 questionários intencionais. A grande maioria das praias estudadas foram classificadas como de qualidade geoambiental alta. Nestas praias, em geral, existem poucas edificações ao longo da zona costeira e os seus ecossistemas ainda encontram-se pouco alterados. Apenas o trecho mais próximos à zona urbana do município de Ilhéus, na praia de São Miguel, obteve uma classificação de qualidade geoambiental baixa, devido principalmente à intensa urbanização e às condições de severa erosão do seu litoral. Todas das praias estudadas apresentaram uma qualidade de infraestrutura baixa ou média, apresentando diversos trechos de praias desertas e semidesertas sem nenhum tipo de infraestrutura recreacional. A análise conjunta dos indicadores geoambientais e de infraestrutura indicou que todas as outras foram classificadas como qualidade recreacional média, exceto a praia Jóia do Atlântico – trecho 1 que apresentou uma alta qualidade recreacional.Esta pesquisa fornece subsídios que podem auxiliar os municípios na alocação dos seus recursos, de forma a garantir um uso mais racional e sustentável de sua zona costeira

Tamanho ótimo de parcelas experimentais para o cultivo de mamoeiro

The objective of this work was to determine the optimal size of experimental plots for the evaluation of agronomic characteristics and fruit quality of papaya, by the linear model of plateau response, under soil and climatic conditions of the Recôncavo Baiano region, in the state of Bahia, Brazil. The experiment consisted of a uniformity test, with the papaya lineage L78, at 3×2 m spacing, in 16 rows with 22 plants, totaling 352 plants and 2,112 m2 useful area. Each plant was considered as a basic unit, and 11 forms of pre-established plots, with rectangular and row formats, were obtained. The agronomic characteristics and fruit quality were evaluated in the plots. Optimal plot size varied greatly among the variables related to agronomic characteristics, with a greater participation of the variable number of marketable fruit per plant at 14 months (16 basic units). The optimal plot size for the evaluation of the agronomic characteristics and fruit quality in papaya is eight experimental units, with 48 m2 area, at a spacing of 3 m between rows and 2 m between papaya plants.O objetivo deste trabalho foi determinar o tamanho ótimo de parcela experimental para avaliação de características agronômicas e qualidade de fruto de mamoeiro, por meio do modelo linear de resposta platô, nas condições edafoclimáticas do Recôncavo Baiano, no Estado da Bahia. O experimento consistiu de um teste de uniformidade, com a linhagem de mamoeiro L78, no espaçamento 3×2 m, em 16 fileiras com 22 plantas, com o total de 352 plantas e área útil de 2.112 m2. Cada planta foi considerada como unidade básica, tendo-se obtido 11 formas de parcelas pré-estabelecidas, com formatos retangulares e em fileiras. As características agronômicas e a qualidade dos frutos foram avaliadas nas parcelas. O tamanho ótimo de parcela variou muito entre as variáveis relativas às características agronômicas, com maior participação da variável número de frutos comerciais aos 14 meses (16 unidades básicas). O tamanho ótimo de parcela para avaliação das características agronômicas e da qualidade do fruto em mamoeiro é de oito unidades experimentais, com área de 48 m2 no espaçamento de 3 m entre fileiras e 2 m entre plantas de mamoeiro

Commercialization of a critically endangered species (largetooth sawfish, Pristis perotteti) in fish markets of northern Brazil: Authenticity by DNA analysis

AbstractPristis perotteti, the largetooth sawfish, is one of most endangered elasmobranchs because of fisheries and habitat degradation. Its commercialization in Brazil is prohibited, but fresh or salted fillets of this fish can be found in markets, labeled as “sharks”. In this study we performed genetic analyses on “shark” samples from two important fishery-trading ports in northern Brazil (Vigia and Bragança). Based on partial DNA sequences of the mitochondrial 16S and Cyt b genes, 24 (55%) out of 44 samples were unequivocally identified as P. perotteti while the others comprised eight species of the families Carcharhinidae and Ginglymostomatidae. These results show that fishing surveillance and monitoring have not been effective to prohibit the commercialization of this highly endangered species

Avaliação da qualidade de estudos clínicos e seu impacto nas metanálises

OBJETIVO: Analisar se diferentes instrumentos de avaliação de qualidade, aplicados a um grupo de estudos clínicos que se correlacionam e qual seu impacto no resultado na metanálise. MÉTODOS: Foram analisados 38 estudos clínicos randomizados e controlados, selecionados para a revisão sistemática sobre a eficácia terapêutica do Interferon Alfa no tratamento da hepatite crônica pelo vírus B. Utilizaram-se os seguintes instrumentos: Maastricht (M), Delphi (D) e Jadad (J) e o método da Colaboração Cochrane (CC), considerado padrão-ouro. Os resultados definidos pelos três instrumentos foram comparados pelo teste de Correlação de Spearman. O teste de Kappa (K) avaliou a concordância entre os revisores na aplicação dos instrumentos e o teste de Kappa ponderado analisou o ordenamento de qualidade definido pelos instrumentos. O clareamento do HBV-DNA e HbeAg foi o desfecho avaliado na metanálise. RESULTADOS: Os estudos foram de regular e baixa qualidade. A concordância entre os revisores foi, de acordo com o instrumento: D=0.12, J=0.29 e M=0.33 e CC= 0,53. A correlação foi moderada e homogênea (D/J=0,51; D/M=0,53 e J/M=0,52). Os resultados da metanálise (HBV-DNA), variaram de RR=0,71; IC 95%: 0,66-0,77 a RR=0,67; IC 95%: 0,58-0,79 e (HbeAg) de RR=0,85; IC 95%: 0,80-0,90 a RR=0,85; IC 95%:0,77-0,93, dependendo da qualidade dos estudos incluídos. CONCLUSÕES: Os instrumentos de avaliação de qualidade têm boa correlação. Nas revisões sistemáticas que apontem à mesma direção do efeito, a avaliação pode não alterar significantemente seu resultado. O método da Colaboração Cochrane é o mais reprodutível e de simples aplicação.OBJECTIVE: To evaluate whether different quality assessment tools applied to a group of clinical trials could be correlated, and what would be their impact on meta-analysis results. METHODS: Thirty-eight randomized controlled clinical trials were analyzed. These had been selected for a systematic review of the therapeutic efficacy of alpha interferon for treating chronic hepatitis B. The following tools were utilized: Maastricht (M), Delphi (D), Jadad (J) and the Cochrane Collaboration (CC) method (gold standard). The Spearman correlation coefficient was used to compare the results from the three methods. The Kappa test was used to assess the concordance between the reviewers in applying the tools, and the weighted Kappa test was applied to compare the quality ranking determined by the tools. The outcomes assessed in the meta-analyses were clearance of HBV-DNA and HBeAg. RESULTS: The studies presented regular to low quality. The concordance between reviewers varied according to the instrument utilized: D=0.12; J=0.29; M=0.33; and CC=0.53. The correlation was moderate and homogeneous (D/J=0.51; D/M=0.53; and J/M=0.52). Thje meta-analysis result relating to HBV-DNA ranged from RR=0.71 (95% CI: 0.66-0.77) to RR=0.67 (95% CI: 0.58-0.79). For HBeAg, the results ranged from RR=0.85 (95% CI: 0.80-0.90) to RR=0.85 ( 95% CI: 0.77-0.93). These results depended on the quality of the studies included. CONCLUSIONS: The quality assessment tools presented good correlation. In systematic reviews with the same direction of effect, the quality assessment may not significantly change the results. The Cochrane Collaboration method was the most reproducible method and easiest to apply

High rate of viral identification and coinfections in infants with acute bronchiolitis

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis. INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear. METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission. RESULTS: We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes. CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.Sociedade Beneficiente Israelita Brasileira Hospital Israelita Albert Einstei

High Rate of Viral Identification and Coinfections in Infants with Acute Bronchiolitis

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis.INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear.METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission.RESULTS: We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes.CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.Sociedade Beneficiente Israelita Brasileira Hospital Israelita Albert EinsteinHosp Israelita Albert Einstein, Dept Saude Materno Infantil, São Paulo, BrazilHosp Israelita Albert Einstein, Ctr Pesquisa Expt, Inst Ensino & Pesquisa, São Paulo, BrazilHosp Israelita Albert Einstein, UPA, São Paulo, BrazilUniv São Paulo, Virol Lab, Inst Trop Med, São Paulo, BrazilUniversidade Federal de São Paulo, Fac Med, Hosp Clin, Inst Crianca, São Paulo, BrazilUniversidade Federal de São Paulo, Fac Med, Hosp Clin, Inst Crianca, São Paulo, BrazilWeb of Scienc

Historical Evolution of the Use of Digital Technology in Teaching Mathematics in Brazilian Classrooms

Digital technologies are important tools to adapt the teaching of mathematics to students, but even with a wide use there are few studies historically detailing this mode of teaching, so this work aims to historically demonstrate the evolution of the technologies used. To achieve this objective, a bibliographic review was carried out in the SCIELO, SBEM, SBM and PROFMAT databases, obtaining as a result 15 articles that use some resources of digital technology as a tool for teaching mathematics, thus managing to have a timeline that includes the computer, diskette, CD/DVD, webcam, digitizing tablet, video projector, digital whiteboard, and some mathematical software, concluding that teachers already use digital technology in the classroom as a means of improving the teaching-learning process