Epidemiological methods

Mendelian randomisation is an accessible and valuable epidemiological approach to provide insight into the causal nature of relationships between risk factor exposures and disease outcomes. However, if performed without critical thought, we may simply have replaced one set of implausible assumptions (no unmeasured confounding or reverse causation) with another set of implausible assumptions (no pleiotropy or other instrument invalidity). The most critical decision to avoid pleiotropy is which genetic variants to use as instrumental variables. Two broad strategies for instrument selection are a biologically motivated strategy and a genome-wide strategy; in general, a biologically motivated strategy is preferred. In this review, we discuss various ways of implementing a biologically motivated selection strategy: using variants in a coding gene region for the exposure or a gene region that encodes a regulator of exposure levels, using a positive control variable and using a biomarker as the exposure rather than its behavioural proxy. In some cases, a genome-wide analysis can provide important complementary evidence, even when its reliability is questionable. In other cases, a biologically-motivated analysis may not be possible. The choice of genetic variants must be informed by biological and functional considerations where possible, requiring collaboration to combine biological and clinical insights with appropriate statistical methodology.

It is expected that both noise and activity distribution can have impact on the detectability of a myocardial defect in a cardiac PET study. In this work, we performed phantom studies to investigate the detectability of a defect in the myocardium for different noise levels and activity distributions. We evaluated the performance of three reconstruction schemes: Filtered Back-Projection (FBP), Ordinary Poisson Ordered Subset Expectation Maximization (OP-OSEM), and Point Spread Function corrected OSEM (PSF-OSEM). We used the Channelized Hotelling Observer (CHO) for the task of myocardial defect detection. We found that the detectability of a myocardial defect is almost entirely dependent on the noise level and the contrast between the defect and its surroundings.

Background-Community viral load (CVL) estimates vary based on analytic methods. We extended the CVL concept and used data from the Veterans Affairs Healthcare System (VA) to determine trends in the healthcare system viral load (HSVL), sensitivity to varying definitions of the clinical population, and assumptions regarding missing data. Methods-We included HIV-infected patients in the Veterans Aging Cohort Study, 2000-2010, with >1 documented CD4 count, HIV-1 RNA or antiretroviral prescription (N=37,318). We

Asthma is a heterogeneous outcome and how the condition should be measured to best capture clinically relevant disease in epidemiologic studies remains unclear. We compared three methods of measuring asthma in the Danish National Birth Cohort (n.50.000). When the children were 7 years old, the prevalence of asthma was estimated from a self-administered questionnaire using parental report of doctor diagnoses, ICD-10 diagnoses from a population-based hospitalization registry, and data on anti-asthmatic medication from a population-based prescription registry. We assessed the agreement between the methods using kappa statistics. Highest prevalence of asthma was found using the prescription registry (32.2%) followed by the self-report (12.0%) and the hospitalization registry (6.6%). We found a substantial non-overlap between the methods (kappa = 0.21-0.38). When all three methods were combined the asthma prevalence was 3.6%. In conclusion, selfreported asthma, ICD-10 diagnoses from a hospitalization registry and data on anti-asthmatic medication use from a prescription registry lead to different prevalences of asthma in the same cohort of children. The non-overlap between the methods may be due to different abilities of the methods to identify cases with different phenotypes, in which case they should be treated as separate outcomes in future aetiological studies.

Asthma is a heterogeneous outcome and how the condition should be measured to best capture clinically relevant disease in epidemiologic studies remains unclear. We compared three methods of measuring asthma in the Danish National Birth Cohort (n.50.000). When the children were 7 years old, the prevalence of asthma was estimated from a self-administered questionnaire using parental report of doctor diagnoses, ICD-10 diagnoses from a population-based hospitalization registry, and data on anti-asthmatic medication from a population-based prescription registry. We assessed the agreement between the methods using kappa statistics. Highest prevalence of asthma was found using the prescription registry (32.2%) followed by the self-report (12.0%) and the hospitalization registry (6.6%). We found a substantial non-overlap between the methods (kappa = 0.21-0.38). When all three methods were combined the asthma prevalence was 3.6%. In conclusion, selfreported asthma, ICD-10 diagnoses from a hospitalization registry and data on anti-asthmatic medication use from a prescription registry lead to different prevalences of asthma in the same cohort of children. The non-overlap between the methods may be due to different abilities of the methods to identify cases with different phenotypes, in which case they should be treated as separate outcomes in future aetiological studies.

To quantitatively assess the impact of selection bias caused by nonparticipation in a multinational case-control study of mobile phone use and brain tumor. METHODS: Non-response questionnaires (NRQ) were completed by a sub-set of nonparticipants. Selection bias factors were calculated based on the prevalence of mobile phone use reported by nonparticipants with NRQ data, and on scenarios of hypothetical exposure prevalence for other nonparticipants. RESULTS: Regular mobile phone use was reported less frequently by controls and cases who completed the NRQ (controls, 56%; cases, 50%) than by those who completed the full interview (controls, 69%; cases, 66%). This relationship was consistent across study centers, sex, and age groups. Lower education and more recent start of mobile phone use were associated with refusal to participate. Bias factors varied between 0.87 and 0.92 in the most plausible scenarios. CONCLUSIONS: Refusal to participate in brain tumor case-control studies seems to be related to less prevalent use of mobile phones, and this could result in a downward bias of around 10% in odds ratios for regular mobile phone use. The use of simple selection bias estimation methods in case-control studies can give important insights into the extent of any bias, even when nonparticipant information is incomplete.

The concept of relative risk (RR) as an incidence rate ratio is extended to a ratio of derivatives of cumulative occurrences of events with respect to any continuous variable whose domain is partitioned in sub-domains of study and referent groups to be contrasted. RR, thus expressed as a function, allows the identification of key values of the independent variable through which effect, as a relation between sub-domains, is modulated. The effect of sex over age of occurrence of myocardial infarction in a sample of Brazilian patients is analysed. Male sex, as contrasted to female, is acknowledged as a risk factor for the disease but it is known that this risk wanes with aging. Derivatives of cumulative occurrences with respect to age are calculated for men and women. Given the normal distribution of these occurrences, derivatives are found to be very similar to the corresponding normal density functions, with difference not greater than 0.005. This provides an easy way of identifying the derivatives whose ratio is likewise easily calculated. Results suggest that, in the Brazilian sample of patients studied, the greatest men to women RR is 1.9 at the age of 23.5 years and that at the age of 61.2 years risks become evens.

Background: Expanding access to highly active antiretroviral therapy (HAART) has become an important approach to HIV prevention in recent years. Previous studies suggest that concomitant changes in risk behaviours may either help or hinder programs that use a Treatment as Prevention strategy. Analysis: We consider HIV-related risk behaviour as a social contagion in a deterministic compartmental model, which treats risk behaviour and HIV infection as linked processes, where acquiring risk behaviour is a prerequisite for contracting HIV. The equilibrium behaviour of the model is analysed to determine epidemic outcomes under conditions of expanding HAART coverage along with risk behaviours that change with HAART coverage. We determined the potential impact of changes in risk behaviour on the outcomes of Treatment as Prevention strategies. Model results show that HIV incidence and prevalence decline only above threshold levels of HAART coverage, which depends strongly on risk behaviour parameter values. Expanding HAART coverage with simultaneous reduction in risk behaviour act synergistically to accelerate the drop in HIV incidence and prevalence. Above the thresholds, additional HAART coverage is always sufficient to reverse the impact of HAART optimism on incidence and prevalence. Applying the model to an HIV epidemic in Vancouver, Canada, showed no evidence of HAART optimism in that setting. Our results suggest that Treatment as Prevention has significant potential for controlling the HIV epidemic once HAART coverage reaches a threshold. Furthermore, expanding HAART coverage combined with interventions targeting risk behaviours amplify the preventive impact, potentially driving the HIV epidemic to elimination.

The health and economic crisis caused by the Covid-19 pandemic has grown into a political crisis. It manifests itself primarily in challenges to the institutions of liberal democracy, particularly in ensuring a legitimate legal and political framework for action and crisis management in an emergency situation. This paper examines the implementation of public health measures to protect life and health (epidemiological measures, vaccinations), which by their very nature involve restrictions on civil liberties, and analyzes their legitimacy and appropriateness against the standards of liberal democracy. The theoretical and legal-political framework of the analysis is the relationship between freedom and safety, i.e. between the civil rights and liberties guaranteed in liberal democracy and the right to life and health as a fundamental human right. Based on the distinction between these two concepts and the analysis of the scope and manner of the implementation of public health measures – especially in the current context of the crisis of liberal democracy and the populist instrumentalization of civil rights for certain political goals and the state of infodemics – the specifics of this relationship are determined. Following the findings of this analysis, it is concluded that civil rights and human rights are not mutually exclusive, despite the competitive relationship and tension between individual liberty and public security – which is particularly emphasized in a pandemic situation. On the contrary, they complement each other and are prerequisites for each other. This path points to the possibilities of achieving a balance between them, and thus to the possibilities of overcoming the crisis caused by the pandemic.

Introduction: Our study aims to estimate the characteristics & causes of TSCI at King Fahad Medical City (KFMC) in Riyadh city in order to hypothesize strategy for primary prevention of traumatic spinal cord injury. Method: Cross-sectional, Retrospective study was conducted on all TSCI patients who aged 14 and above and who were admitted in rehabilitation center of King Fahad Medical City from January 2012 to December 2015. Furthermore, a descriptive analysis was conducted while considering factors including age, gender, marital status, educational level and causes of injury and characteristics of injury. Results: Total of 216 patients were admitted during this period, mean age was 28.94, majority of patients were male (86.5%), 71.7% of total patients were high school level of education or less, 68% were single, RTA was the main cause with 90.7% and the main result of TSCI was complete paraplegia 37%. Furthermore, statistically we found that male are at a low risk of having incomplete paraplegia compared to female (p = 0.035, RRR=0.35). Conclusion: The rate of TSCI related to RTA has increased in Saudi Arabia in previous years. Despite the government's efforts to decrease RTA. It's clear that we need TSCI registry data developed on the basis of international data standards to have a clear idea about the exact etiology of TSCI in Saudi Arabia. These will assist in planning for primary prevention.

Background Globalization carries information and technology opportunities and risks in widened inequalities, a resurgence of old health risks and reversal of health gains. The paper explores the implications for epidemiological work in southern Africa and through two case studies-occupational health and equity in healthprofiles challenges faced in that region. Occupational epidemiology is confronted by weak monitoring and regulatory systems, healthy worker effects, surveillance filters, and migration. Occupational disease determinants are masked by the combined effects of work, wider environmental risks, and high poverty-related disease. Health burdens associated with new production and trade patterns are thus largely unrecognized. Even when made visible, they may be ignored by economically vulnerable states and workers. Work on equity in health indicates the relevance of social and political determinants in the distribution of health resources. The shift of the cost burden of human immunodeficiency virus (HIV)/AIDS to poor communities and the weak public health response to HIV/AIDS suggest that economic and health reforms associated with globalization have both increased health inequalities and weakened social and political forces promoting equity and solidarity values in public health. Conclusions Epidemiology can demystify disease sources and explain determinants in a manner that impacts on public policy and action. Under current conditions of globalization this implies addressing methodological challenges and enhancing uptake of evidence in policy processes. Given the intensifying political struggle around health resources, increased attention needs to be given to participatory forms of inquiry that strengthen the influence of poor communities and public interest values in health policy.

We introduce a new approach for modeling multivariate overdispersed binomial data, from a plant pathogen complex. After recalling some theoretical foundations of generalized linear models (GLMs) and Copula functions, we show how the later can be used to model correlated observations and overdispersed data. We illustrate this approach using fungal incidence in vegetables, which we analyzed using Gaussian copula with Beta-binomial margins. Compared to classical and generalized linear models, the model using Gaussian copula function best controls for overdispersion, being less prone to the underestimation of standard errors, the major cause of wrong inference in the statistical analysis of plant pathogen complex.

Objective: Environmental exposure to food sources may underpin area level differences in individual risk for overweight. Place of residence is generally used to assess neighbourhood exposure. Yet, because people are mobile, multiple exposures should be accounted for to assess the relation between food environments and overweight. Unfortunately, mobility data is often missing from health surveys. We hereby test the feasibility of linking travel survey data with food listings to derive food store exposure predictors of overweight among health survey participants. Methods: Food environment exposure measures accounting for non-residential activity places (activity spaces) were computed and modelled in Montreal and Quebec City, Canada, using travel surveys and food store listings. Models were then used to predict activity space food exposures for 5,578 participants of the Canadian Community Health Survey. These food exposure estimates, accounting for daily mobility, were used to model self-reported overweight in a multilevel framework. Median Odd Ratios were used to assess the proportion of between-neighborhood variance explained by such food exposure predictors. Results: Estimates of food environment exposure accounting for both residential and non-residential destinations were significantly and more strongly associated with overweight than residential-only measures of exposure for men. For women, residential exposures were more strongly associated with overweight than non-residential exposures. In Montreal, adjusted models showed men in the highest quartile of exposure to food stores were at lesser risk of being overweight considering exposure to restaurants (OR = 0.36 [0.21-0.62]), fast food outlets (0.48 [0.30-0.79]), or corner stores (0.52 [0.35-0.78]). Conversely, men experiencing the highest proportion of restaurants being fast-food outlets were at higher risk of being overweight (2.07 [1.25-3.42]). Women experiencing higher residential exposures were at lower risk of overweight. Conclusion: Using residential neighbourhood food exposure measures may underestimate true exposure and observed associations. Using mobility data offers potential for deriving activity space exposure estimates in epidemiological models.

Background: Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches. Methods: Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience. Results: Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice. Conclusions: Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.

We introduce a new approach for modeling multivariate overdispersed binomial data, from a plant pathogen complex. After recalling some theoretical foundations of generalized linear models (GLMs) and Copula functions, we show how the later can be used to model correlated observations and overdispersed data. We illustrate this approach using fungal incidence in vegetables, which we analyzed using Gaussian copula with Beta-binomial margins. Compared to classical and generalized linear models, the model using Gaussian copula function best controls for overdispersion, being less prone to the underestimation of standard errors, the major cause of wrong inference in the statistical analysis of plant pathogen complex.

Vitor Gouveia de Almeida Master's Student in Management and Public Policies-Fundação Getúlio Vargas http://lattes.cnpq.br/7115189200096362 RESULTS: The costs associated with both scientific research into vaccine development, production, and distribution, as well as with the implementation of quality basic sanitation, are substantial. Brazilian municipalities that prioritize basic sanitation not only achieve a reduction in dengue incidence but also see improvements in combating other neglected diseases. CONCLUSION: The eradication of dengue remains an unresolved issue. However, it is evident that basic sanitation policies, particularly in impoverished areas, are crucial for the sustained reduction of the disease.

Network Biology (ISSN 2220-8879; CODEN NBEICS)
E-mail: [email protected]

Volume 14, Number 3, 1 September 2024 
http://www.iaees.org/publications/journals/nb/articles/2024-14(3)/2024-14(3).asp

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[Front Pages (154K)] [Back Pages (70K)]

Articles

Stability analysis of a predator-prey model using Takagi-Sugeno method
Network Biology, 2024, 14(3): 215-227
Kaladhar Kolla, Khushbu Singh
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Dynamical behavior of an eco-epidemiological model incorporating Holling type-II functional response with prey refuge and constant prey harvesting
Network Biology, 2024, 14(3): 228-241
P. Sireeshadevi, G. Ranjith Kumar
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Analysis of amino acids network based on graph mining
Network Biology, 2024, 14(3): 242-253
Nasrin Irshad Hussain, Kuntala Boruah
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Several ongoing cohort studies in Europe and US use different dietary assessment methods to increase our knowledge about diet and disease relationships concerning cardiovascular disease, osteoporosis and cancer. Diet history methods and food frequency questionnaires are commonly used methods to measure usual food intake in case-control studies and cohort studies. However, misclassification imposed by the methods limit the possibilities of collecting reliable data on dietary intake. The validity of the dietary methods depends on several components, like accurate estimations of frequency and portion sizes, the quality of food composition data bases used, and data collection procedure; all components which are crucial for interpretation of the dietary results. If the food list does not include commonly consumed food items in the chosen study population, or dietary methods with predefined questions are used, the sample characteristics must be homogeneous for several factors like gender, age, ethnicity and social 1071

Objective: Analyze the epidemiological distribution of tuberculosis in port regions in the period 2019-2023 in Brazilian territory. Methodology: This is a descriptive, observational study carried out based on data collected from DATASUS in 2024.
Results and discussion: 7,148 cases of pulmonary tuberculosis were identified in the following port cities: São Luís, Angra dos Reis, Santos, Paranaguá and Tubarão, with the highest prevalence in the city of São Luís - MA. Among the epidemiological characteristics, we found a prevalence in males, between the ages of 30-49 years, of mixed and black ethnicity and with an education level of 5th to 8th grade of elementary school. This pattern is consistent with the profile of port workers, of which approximately 86.3% are men, of mixed or black ethnicity and manual workers. Conclusion: The results showed a slow and gradual increase in the number of tuberculosis cases in the port regions studied, with a significant increase being observed in 2022 in the Angra dos Reis region, making it necessary to be aware of a possible outbreak. It is necessary to maintain surveillance and adopt measures at the three levels of prevention according to the needs of each region in order to reduce the spread of this pathology.

Health institutions may choose to screen newly admitted patients for the presence of disease in order to reduce disease prevalence within the institution. Screening is costly, and institutions must judiciously choose which patients they wish to screen based on the dynamics of disease transmission. Since potentially infected patients move between different health institutions, the screening and treatment decisions of one institution will affect the optimal decisions of others; an institution might choose to ''free-ride'' off the screening and treatment decisions of neighboring institutions. We develop a theoretical model of the strategic decision problem facing a health care institution choosing to screen newly admitted patients. The model incorporates an SIS compartmental model of disease transmission into a game theoretic model of strategic decision-making. Using this setup, we are able to analyze how optimal screening is influenced by disease parameters, such as the efficacy of treatment, the disease recovery rate and the movement of patients. We find that the optimal screening level is lower for diseases that have more effective treatments. Our model also allows us to analyze how the optimal screening level varies with the number of decision makers involved in the screening process. We show that when institutions are more autonomous in selecting whom to screen, they will choose to screen at a lower rate than when screening decisions are more centralized. Results also suggest that centralized screening decisions have a greater impact on disease prevalence when the availability or efficacy of treatment is low. Our model provides insight into the factors one should consider when choosing whether to set a mandated screening policy. We find that screening mandates set at a centralized level (i.e. state or national) will have a greater impact on the control of infectious disease.

The positive mental health and well-being perspective represents innovative public health research of first-rank priority in Europe. Good mental health is both a state and a resource for everyday life. Hence, the concept often refers to a subjective feeling (hedonic component) as well as positive functioning (eudaimonic component). Different conceptualisations of mental health-related issues are a background to this paper, which gives a brief overview of three research issues in the Nordic countries. First, the development in the occurrences of adolescent mental health-related indicators such as life satisfaction, health, sleep, and school pressure. Second, review of Nordic methodological studies reporting on different mental health-related measures. Third, the selection of measures of positive mental health employed in the 2017-2018 Health Behaviour among School-aged Children (HBSC) data collection in the Nordic countries. Using the Nordic HBSC data for 2002-2014, it was found that symptom and problem-oriented analyses of mental health can improve our understanding of the challenges adolescents face. However, there is also a need to examine positive aspects of mental health in order to enhance our understanding of different mental health-related dimensions. New measures were included in the 2017-18 HBSC data collection in the Nordic countries, enabling researchers to answer different research questions including analysing factors mediating and moderating positive mental health among school-aged children. Extending the perspective from a symptom-and problem-oriented view to a more positive and asset-based perspective adds additional value to studies of mental health.

The exposure to green space in early life may support better cognitive aging in later life. However, this exposure is usually measured using the residential location alone. This disregards the exposure to green spaces in places frequented during daily activities (i.e., the 'activity space'). Overlooking the multiple locations visited by an individual over the course of a day is likely to result in poor estimation of the environmental exposure and therefore exacerbates the contextual uncertainty. A child's activity space is influenced by factors including age, sex, and the parental perception of the neighborhood. This paper develops indices of park availability based on individuals' activity spaces (home, school, and the optimal route to school). These measures are used to examine whether park availability in childhood is related to cognitive change much later in life. Multi-level linear models, including random effects for schools, were used to test the association between park availability during childhood and adolescence and cognitive aging (age 70 to 76) in the Lothian Birth Cohort 1936 participants (N = 281). To test for the effect modification, these models were stratified by sex and road traffic accident (RTA) density. Park availability during adolescence was associated with better cognitive aging at a concurrently low RTA density (β = 0.98, 95% CI: 0.36 to 1.60), but not when the RTA density was higher (β = 0.22, 95% CI: −0.07 to 0.51). Green space exposure during early life may be important for optimal cognitive aging; this should be evidenced using activity space-based measures within a life-course perspective.

Background-Community viral load (CVL) estimates vary based on analytic methods. We extended the CVL concept and used data from the Veterans Affairs Healthcare System (VA) to determine trends in the healthcare system viral load (HSVL), sensitivity to varying definitions of the clinical population, and assumptions regarding missing data. Methods-We included HIV-infected patients in the Veterans Aging Cohort Study, 2000-2010, with >1 documented CD4 count, HIV-1 RNA or antiretroviral prescription (N=37,318). We

Background: It has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis. Methods: The study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI) was measured at 8-10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS) in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors. Results: Maternal overweight and obesity were associated with increased risk that the child would require ICS (for BMI$35 kg/m 2 , aOR = 1.30, 95%CI = 1.10-1.52 compared with normal weight mothers) in children aged 6-12 years. Similar effects were seen in younger children, but in children aged 13-16 years, maternal obesity (BMI$30) was related to increased risk of ICS use in girls (aOR = 1.28, 95%CI = 1.07-1.53) but not boys (OR = 1.05, 95%CI = 0.87-1.26). The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use. Conclusion: Maternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects of maternal BMI may be due to shared genetic or environmental risk factors.

The positive mental health and well-being perspective represents innovative public health research of first-rank priority in Europe. Good mental health is both a state and a resource for everyday life. Hence, the concept often refers to a subjective feeling (hedonic component) as well as positive functioning (eudaimonic component). Different conceptualisations of mental health-related issues are a background to this paper, which gives a brief overview of three research issues in the Nordic countries. First, the development in the occurrences of adolescent mental health-related indicators such as life satisfaction, health, sleep, and school pressure. Second, review of Nordic methodological studies reporting on different mental health-related measures. Third, the selection of measures of positive mental health employed in the 2017-2018 Health Behaviour among School-aged Children (HBSC) data collection in the Nordic countries. Using the Nordic HBSC data for 2002-2014, it was found that symptom and problem-oriented analyses of mental health can improve our understanding of the challenges adolescents face. However, there is also a need to examine positive aspects of mental health in order to enhance our understanding of different mental health-related dimensions. New measures were included in the 2017-18 HBSC data collection in the Nordic countries, enabling researchers to answer different research questions including analysing factors mediating and moderating positive mental health among school-aged children. Extending the perspective from a symptom-and problem-oriented view to a more positive and asset-based perspective adds additional value to studies of mental health.

Glaucoma is characterized by anatomical and functional changes
which result in progressive loss of retinal ganglion cells and damage to the optic nerve. This optic neuropathy represents a silent threat to visual health, often triggering irreversible damage before it is even detected. Due to the impact that this disease has on both society and public health, it was considered extremely relevant to identify the epidemiological profile of hospital admissions resulting from glaucoma in the state of Rio Grande do Sul. A cross-sectional descriptive study was carried out based on data from the Department of Informatics of the Unified Health System (DATASUS). Data were collected regarding the number of deaths, sex, age group and race of patients hospitalized for glaucoma between the years 2011 and 2020. In total, 808 hospitalizations due to glaucoma were recorded in the state, with the highlight being the years of 2018 and 2019, with 176 (21.78%) and 195 (24.13%) hospitalizations.


Of these cases, 429 were female, representing 53.09% of the total. Regarding the age group, the group between 60 and 69 years old had the highest number of hospitalizations, equivalent to 27.72% of visits, while the group between 20 and 29 years old had the lowest, with less than 5% of visits. Regarding color/race, 176 records did not contain information and of the available records, the largest portion affected was Caucasian with 504 cases respectively. The findings suggest a continued need for surveillance and public health strategies to address this disease, particularly in older populations. The need for tracking the disease and carrying out more detailed studies was identified so that diagnoses can be made early so that, by monitoring the progression of the disease, a better quality of life can be guaranteed for patients.

Dengue is an acute febrile illness of great importance for global public health. caused by an arbovirus that has its spread favored in environments with tropical climate characteristics, it tends to have seasonal patterns, with a peak incidence generally during and after the rainy seasons. The Brazilian epidemiological scenario of arboviruses is worrying due to the occurrence of the triple epidemic, dengue, chikungunya fever (chikf) and congenital zika virus syndrome (zikv). The expansion of dengue occurrence areas in Brazil is associated both with urbanization, without the proper sanitation structure, and with the globalization of the economy. The work aimed to compare the incidence of dengue cases in the years 2015 to 2019 in Brazil, between the five regions and between the 27 states, based on data collected in Datasus and analyzed with statistical tools. the years 2015, 2016 and 2019 presented the highest numbers of cases, with the southeast region having the highest incidence and the north region having the lowest incidence. After processing the data, it was possible to conclude that there was a significant difference between the number of dengue cases between states and regions in the established period.

Previous research showed that younger adult males in the USA have, since the 1950s, died at a faster rate than females of the same age. In this paper, we quantify this difference, and explore possible explanations for the differences at different ages and in different years. Using data from the Human Mortality Database (HMD), the number of additional male deaths per 10 000 female deaths was calculated for each year from 1933 to 2010, and for each year of age from 0 to 60 years, for the USA, and a number of other countries for comparison. The data were explored visually using shaded contour plots. Gender differences in excess mortality have increased. Coming of age (between the ages of 15 and 25 years of age) is especially perilous for men relative to women now compared with the past in the USA; the visualisations highlight this change as important. Sex differences in mortality risks at various ages are not static. While women may today have an advantage when it comes to life expecta...

Previous research showed that younger adult males in the USA have, since the 1950s, died at a faster rate than females of the same age. In this paper, we quantify this difference, and explore possible explanations for the differences at different ages and in different years. Using data from the Human Mortality Database (HMD), the number of additional male deaths per 10 000 female deaths was calculated for each year from 1933 to 2010, and for each year of age from 0 to 60 years, for the USA, and a number of other countries for comparison. The data were explored visually using shaded contour plots. Gender differences in excess mortality have increased. Coming of age (between the ages of 15 and 25 years of age) is especially perilous for men relative to women now compared with the past in the USA; the visualisations highlight this change as important. Sex differences in mortality risks at various ages are not static. While women may today have an advantage when it comes to life expecta...

INTRODUCTION: Transsexuality is the state where the individual does not identify with the gender assigned at birth. From the 90s onwards, transsexual activism became legitimized in Brazil, bringing greater rapprochement between it and the State. In this scenario, in 2008 the transsexualization process was instituted via the Unified Health System (SUS), and only in 2013 was the inclusion of trans men. When gender affirmation is carried out, trans men still need to face social stigmas and confront their current status. GOAL: To analyze stigmas, vulnerabilities and challenges experienced by trans men when accessing the SUS. METHODS: This is an integrative literature review based on the theme of prejudices and social stigmas attributed to trans men within the Unified Health System. The Scielo, Scholar Google and Lilacs databases were used. The descriptors used were: “Social Stigma”; “Trans Men”; “Unified Health System” and “Prejudice”.  RESULTS AND DISCUSSION: After reading and analysis, 5 (five) articles were selected. The literature pointed out that situations of embarrassment and discrimination are constantly experienced by trans men within the SUS. This condition is caused by a sequence of factors, the first of which is the lack of preparation in the training of health professionals to deal with this population. Another factor cited is disrespect for one's social name, resulting in a reluctance to seek medical treatment, resulting in health problems. Thus, associated with these factors, we have difficulty for trans men to confront their current status through consultations with the gynecologist, making the situation embarrassing. CONCLUSION: The transsexualization process introduced in the SUS is recent. In addition to the prejudice and stigma that trans men suffer, there is the problem faced in relation to the gynecological health service, resulting in resistance to the public health service. Given the factors exposed, the damage to the physical and mental health of trans men becomes evident, resulting in a public health problem.

Dengue is an infectious disease transmitted by the Aedes aegypti mosquito, which can cause serious symptoms and even lead to death. In recent years, an epidemiological worsening of dengue has been observed in the country, and to this end, federal entities are applying measures to combat this scenario. This study aimed to carry out an epidemiological survey of dengue in Minas Gerais during the year 2023, evaluating the incidence, associated risk factors and geographic distribution of the disease. Dengue case notification data from all municipalities in Minas Gerais were analyzed, with a population-based descriptive analysis, using secondary data from official public health sources, using the TABNET tool from the Information Department of the Unified Health System (DATASUS). Fourteen macro-regions of the state of Minas Gerais were evaluated, including the South, West, East, Southeast, North, Center South, Center and Jequitinhonha regions. The data collected were on disease classification criteria, its evolution, patient hospitalization and death. The results showed that the incidence of dengue in Minas Gerais was 392,265 reported cases, including cases of dengue with warning signs and severe dengue. The South region had the highest number of notifications, with a total of 46,884 cases of hospitalization for dengue, being stratified into Ignored/White, hospitalized and non-hospitalized. It is concluded that understanding the incidence, associated risk factors and geographic distribution of dengue are crucial to inform prevention and control strategies for the disease.

Background: A fundamental aspect of epidemiological studies concerns the estimation of factor-outcome associations to identify risk factors, prognostic factors and potential causal factors. Because reliable estimates for these associations are important, there is a growing interest in methods for combining the results from multiple studies in individual participant data meta-analyses (IPD-MA). When there is substantial heterogeneity across studies, various random-effects meta-analysis models are possible that employ a one-stage or two-stage method. These are generally thought to produce similar results, but empirical comparisons are few. Objective: We describe and compare several one-and two-stage random-effects IPD-MA methods for estimating factoroutcome associations from multiple risk-factor or predictor finding studies with a binary outcome. One-stage methods use the IPD of each study and meta-analyse using the exact binomial distribution, whereas two-stage methods reduce evidence to the aggregated level (e.g. odds ratios) and then meta-analyse assuming approximate normality. We compare the methods in an empirical dataset for unadjusted and adjusted risk-factor estimates. Results: Though often similar, on occasion the one-stage and two-stage methods provide different parameter estimates and different conclusions. For example, the effect of erythema and its statistical significance was different for a one-stage (OR = 1.35, p~0:03) and univariate two-stage (OR = 1.55, p~0:12). Estimation issues can also arise: two-stage models suffer unstable estimates when zero cell counts occur and one-stage models do not always converge. Conclusion: When planning an IPD-MA, the choice and implementation (e.g. univariate or multivariate) of a one-stage or two-stage method should be prespecified in the protocol as occasionally they lead to different conclusions about which factors are associated with outcome. Though both approaches can suffer from estimation challenges, we recommend employing the one-stage method, as it uses a more exact statistical approach and accounts for parameter correlation.

We introduce a new approach for modeling multivariate overdispersed binomial data, from a plant pathogen complex. After recalling some theoretical foundations of generalized linear models (GLMs) and Copula functions, we show how the later can be used to model correlated observations and overdispersed data. We illustrate this approach using fungal incidence in vegetables, which we analyzed using Gaussian copula with Beta-binomial margins. Compared to classical and generalized linear models, the model using Gaussian copula function best controls for overdispersion, being less prone to the underestimation of standard errors, the major cause of wrong inference in the statistical analysis of plant pathogen complex.

We introduce a new approach for modeling multivariate overdispersed binomial data, from a plant pathogen complex. After recalling some theoretical foundations of generalized linear models (GLMs) and Copula functions, we show how the later can be used to model correlated observations and overdispersed data. We illustrate this approach using fungal incidence in vegetables, which we analyzed using Gaussian copula with Beta-binomial margins. Compared to classical and generalized linear models, the model using Gaussian copula function best controls for overdispersion, being less prone to the underestimation of standard errors, the major cause of wrong inference in the statistical analysis of plant pathogen complex.

ABSTRACT

Introduction
The conduct of the non-exposure assigning, cross-sectional survey on Knowledge Attitudes,
Behaviour and Practices provided data through an epidemiologic approach in the process of the
identification, characterization and quantification of demand side risks linked to the determinants
of disclosure of HIV sero-positive status by female PLHIV 15-49 years to partner for analysis.
Objective The socio-ecological model provided a focus for synthesis of descriptive cross-
sectional analysis of KABP survey data connected to disclosure of sero-positive status process
indicators associative of individual, dyadic and group influences to characterize the risk factors
that are disclosure determinants among female PLHIV 15-49 years.

Methodology
The data analysis was conducted on survey datasets obtained from the stratified random
sampling based on the Cochran approach of a 385-sample size from a population of female
PLHIV between the ages of 15-49 years of age from 35 ART Clinics. Only 30% or 101 of the
questionnaires (8 Demographic and 13 Categorical indicators) were returned and met eligibility
criteria. Results Microsoft Excel and SPSS 25 were used to analyze the datasets from the KABP
survey, where n=101 and HIV sero positive status disclosure observed was 56.32%. The
parametric bivariate Pearson correlation (95% CI) was used to derive p (0.799, 0.58) and r
(0.026, -0.067) values for household Status and family type respectively indicating statistically
non-significant relationship with HIV sero-positive disclosure irrespective of linear correlation,
however the family type was more significant. Conclusion and Recommendations Even though the null hypothesis was significant at 0.01 (2-tailed), a weak negative and positive linear
correlation was observed between the disclosure of HIV sero-positive status to partner relative to
the family and the household type respectively thus female PLHIV 15-49 years with concurrent
dyadic sexual partners increases the risk of non or partial-disclosure and must be addressed
through qualitative adherence counseling to ensure that the UNAIDS goals of 95% reduction of
the level of new HIV infections by 2030 is realized.

KEYWORDS: Disclosure, People Living with HIV (PLHIV), Women-of-Reproductive Age,
Stigma and discrimination, Epidemiologic approach, Cross-sectional Survey

Objective: Predicting the risk of future events is an essential part of health economic simulation models. In pursuit of this goal, the current study aims to predict the risk of developing first and second acute myocardial infarction, heart failure, nonacute ischaemic heart disease, and stroke after diagnosis in patients with type 2 diabetes, using data from the Swedish National Diabetes Register. Material and Methods: Register data on 29,034 patients with type 2 diabetes were analysed over five years of follow up (baseline 2003). To develop and validate the risk equations, the sample was randomly divided into training (75%) and test (25%) subsamples. The Weibull proportional hazard model was used to estimate the coefficients of the risk equations, and these were validated in both the training and the test samples. Results: In total, 4,547 first and 2,418 second events were observed during the five years of follow up. Experiencing a first event substantially elevated the risk of subsequent events. There were heterogeneities in the effects of covariates within as well as between events; for example, while for females the hazard ratio of having a first acute myocardial infarction was 0.79 (0.70-0.90), the hazard ratio of a second was 1.21 (0.98-1.48). The hazards of second events decreased as the time since first events elapsed. The equations showed adequate calibration and discrimination (C statistics range: 0.70-0.84 in test samples). Conclusion: The accuracy of health economic simulation models of type 2 diabetes can be improved by ensuring that they account for the heterogeneous effects of covariates on the risk of first and second cardiovascular events. Thus it is important to extend such models by including risk equations for second cardiovascular events.

Einfluss von Registern auf die Versorgungsqualität Hintergrund Der Lebenszyklus diagnostischer und therapeutischer Interventionen (im Folgenden sperrig als "Gesundheitsdienstleistungen" bezeichnet) durchläuft verschiedene, hierarchisch grob gliederbare Stufen der wissenschaftlichen Evaluation. Obwohl sich diese im Einzelfall nur schwer voneinander trennen lassen, hat es sich bewährt, im Einklang mit der englischen Nomenklatur zwischen 4 "efficacy" (Wirkung), 4 "effectiveness" (Wirksamkeit) und 4 "efficiency" (Nutzen)

This study addresses the relevance of early detection of prostate disorders, highlighting the prevalence of problems associated with the prostate in men who reach an older age. It is observed that, in developed countries, male life expectancy is 79.5 years, with approximately 50% of individuals over 65 years of age presenting complaints related to prostatic obstruction, with 15% undergoing surgery. The main objective of the research is to compare and calculate the rate of Urinary Tract Infection (UTI) in patients undergoing prostate surgery at the Hospital de Clínicas de Uberlândia with data from the Ministry of Health (MS) and scientific studies. Carried out over six months, the study adopts a quantitative, documentary and retrospective approach, analyzing 77 medical records of patients undergoing prostate surgery. Endoscopic prostate resection stood out as the most performed surgery (40.26%), followed by prostatectomy due to tumor (33.77%). The average length of stay was 6.5 days, with an average age of 67 years. The use of prophylactic (88.31%) and postoperative (20.78%) antibiotics was significant. Postoperative urine cultures were performed in 19.48% of patients, identifying UTI in 5.19% of cases. Despite the postoperative UTI rate being similar to the literature, it is observed that it may not reflect reliable results due to cases of return to the emergency room with UTI symptoms, antibiotic medication without laboratory confirmation and lack of reevaluation of contaminated cultures. The study highlights the importance of continuous health care, especially at advanced ages, and highlights the Blue November campaign as a crucial initiative to raise awareness about the early detection of prostate cancer.

Measures of chronic degenerative disease diffusion, such as incidence and prevalence rates, are a basic need for epidemiologists and others working in many fields of human sciences. Equations relating death probabilities to incidence and survival probabilities for chronic degenerative diseases are derived from a cohort point of view. A maximum likelihood approach is adopted for the estimation of incidence as a function of time related covariates. When time series of mortality data are available, the model can be used to describe and analyse levels and dynamics of morbidity. A trial application to lung and breast cancer is given for the province of Varese, Italy, where incidence data are available from the Lombardy Cancer Register.