Intervenção breve no tabagismo : abordagem clínica dos médicos portugueses

RESUMO - O tabagismo é o principal factor de risco evitável em saúde nos países europeus, contribuindo para o aumento da mortalidade prematura, estando associado a inúmeras doenças. A epidemia tabágica é uma preocupação em Saúde Pública, sendo essencial o investimento na sua prevenção e controlo. A cessação tabágica é uma das estratégias para o controlo desta epidemia, surgindo a intervenção breve como uma comprovada medida custo-efetiva. Contudo, e apesar das guidelines, a intervenção breve não está amplamente disseminada na prática clínica dos profissionais de saúde. Neste sentido, este estudo teve como objetivo avaliar as práticas clíniicas autoreportadas dos médicos portugueses na intervenção breve em tabagismo. É um estudo observacional descritivo transversal e exploratório. A amostra é constituída por médicos que participaram em duas conferências médicas distintas e que aceitaram responder a um questionário (n=549). O tratamento estatístico foi efetuado recorrendo ao Statistical Package for the Social Sciences (SPSS), versão 21. Foram efetuadas uma análise descritiva e inferencial, assim como uma regressão logística. Analisando os dados, os resultados apontam para a formação pós-graduada e a prática de cessação tabágica como dois fatores que influenciam positivamente a atuação dos médicos na intervenção breve. A intervenção breve é fundamental para aumentar as taxas de cessação tabágica. Para que a implementação seja eficaz é necessário apostar na formação pré e pós-graduada dos médicos e outros profissionais de saúde, associando essa formação ao treino prático que possibilite o desenvolvimento de competências específicas.

Trends in lung cancer among young European women: the rising epidemic in France and Spain.

Lung cancer mortality in young women in the European Union (EU) has steadily increased until the mid 1990 s and has levelled off thereafter, but trends have been heterogeneous in various countries. We analyzed therefore age-standardized trends in lung cancer mortality in young women (20-44) for the 6 major European countries, using joinpoint regression. In the early 1970s the highest lung cancer mortality in young women was in the UK (2.1/100,000). UK rates, however, steadily declined and in 2000-2004 they were the lowest of all 6 major EU countries (1.2/100,000). The second lowest rate in 2000-2002 was in Italy, whose rates remained around 1.1/100,000 between 1970 and 1994, and increased to 1.4 thereafter. In Germany and Poland, lung cancer rates in young women rose from 0.8-1.0/100,000 in the early 1970s to 1.7-1.9 in the mid 1990 s and levelled off during the last decade. Major rises over recent years were observed in France (from 0.8/100,000 in 1985-1989 to 2.2 in 2000-2003) and in Spain (from 0.8 in the 1985-1989 to 1.7 in 2000-2004). Thus, France showed both the highest rate observed over the last 3 decades and the largest rise over the last 2 decades. Since recent trends in the young give relevant information to the likely future trends in middle age, the female lung cancer epidemic is likely to expand in southern Europe from the current rates of 5.0/100,000 in Spain and 7.7 in France to approach 20/100,000 within the next 2-3 decades. Urgent interventions for smoking cessation in women are therefore required.

How critical is timing for the diagnosis of influenza in general practice?

QUESTIONS UNDER STUDY: The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. PRINCIPLES: A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. RESULTS: 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associated with a diagnosis of influenza. In a multivariable logistic analysis, the best model predicting influenza was the association of a duration of symptom <48 hours, medical attendance at the beginning of the epidemic (weeks 49-50), fever >37.8 and cough, with a sensitivity of 79%, specificity of 69%, positive predictive value of 67%, negative predictive value of 73% and an area under the ROC curve of 0.74. CONCLUSIONS: Besides relevant symptoms and signs, the physician should also consider the duration of symptoms and the epidemiological context (start, peak or end of the epidemic) in his appraisal, since both parameters considerably modify the value of the clinical predictors when assessing the probability of a patient having influenza.

Embonpoint, obésité, genre et inégalités sociales au Canada

La problématique de la surcharge pondérale est pandémique. Un nombre important d’études épidémiologiques robustes mettent en évidence un gradient socio-économique (SSE) en lien avec cette problématique: le risque de surpoids ou d'obésité diminuerait graduellement avec l’accroissement du SSE. Toutefois, les données canadiennes récentes montrent que ce gradient est inversé pour les hommes au Canada. Nos objectifs sont (1) de vérifier si ce phénomène de gradient SSE inversé s’applique autant à l’embonpoint, qu’à l’obésité; (2) nous présenterons et discuterons trois grandes hypothèses susceptibles d'expliquer les inégalités sociales de surcharges pondérales (sociodémographique, habitudes de vie et psychosociale). Méthodologie : nous réalisons nos analyses à partir d’un échantillon de personnes âgées de 25 à 65 ans ayant répondu aux questions de l’Enquête sur la santé dans les collectivités canadiennes cycle 2.2 volet-nutrition (ESCC 2.2). Nous choisissons d’utiliser les données de cette enquête principalement pour ses mesures anthropométriques. Nous utilisons deux indicateurs SSE : le revenu et l’éducation. Nous utilisons des régressions logistiques simples et multinomiales. Nos résultats montrent des gradients SSE inversés entre hommes et femmes pour les liens entre le revenu et l’obésité, mais non pour l’embonpoint. Nous observons des gradients SSE avec l’éducation, mais principalement pour les femmes et l’obésité. Que pour les hommes aucune des hypothèses explicatives n’aura su atténuer l’effet du revenu, tant pour l’embonpoint que pour l’obésité. Chez les femmes l’effet de l’éducation et des habitudes de vie expliquent majoritairement l’effet du revenu sur l’obésité. Conclusion : nous montrons par nos résultats qu’en se concentrant uniquement que sur les aspects individuels de la surcharge pondérale, nous limitons notre compréhension des inégalités sociales en matière de surcharge pondérale, particulièrement celles entre le genre.

Investigations on the Dynamics of Combination Maps and the Analysis of Bifurcation in a Discontinuous Logistic Map

This thesis is a study of discrete nonlinear systems represented by one dimensional mappings.As one dimensional interative maps represent Poincarre sections of higher dimensional flows,they offer a convenient means to understand the dynamical evolution of many physical systems.It highlighting the basic ideas of deterministic chaos.Qualitative and quantitative measures for the detection and characterization of chaos in nonlinear systems are discussed.Some simple mathematical models exhibiting chaos are presented.The bifurcation scenario and the possible routes to chaos are explained.It present the results of the numerical computational of the Lyapunov exponents (λ) of one dimensional maps.This thesis focuses on the results obtained by our investigations on combinations maps,scaling behaviour of the Lyapunov characteristic exponents of one dimensional maps and the nature of bifurcations in a discontinous logistic map.It gives a review of the major routes to chaos in dissipative systems,namely, Period-doubling ,Intermittency and Crises.This study gives a theoretical understanding of the route to chaos in discontinous systems.A detailed analysis of the dynamics of a discontinous logistic map is carried out, both analytically and numerically ,to understand the route it follows to chaos.The present analysis deals only with the case of the discontinuity parameter applied to the right half of the interval of mapping.A detailed analysis for the n –furcations of various periodicities can be made and a more general theory for the map with discontinuities applied at different positions can be on a similar footing

Existence of multiple attractors and the nature of bifurcations in a discontinuous logistic map

We present the analytical investigations on a logistic map with a discontinuity at the centre. An explanation for the bifurcation phenomenon in discontinuous systems is presented. We establish that whenever the elements of an n-cycle (n > 1) approach the discontinuities of the nth iterate of the map, a bifurcation other than the usual period-doubling one takes place. The periods of the cycles decrease in an arithmetic progression, as the control parameter is varied. The system also shows the presence of multiple attractors. Our results are verified by numerical experiments as well.

Chaos in modulated logistic systems

This paper is a review of the work done on the dynamics of modulated logistic systems. Three different problems are treated, viz, the modulated logistic map, the parametrically perturbed logistic map and the combination map obtained by combining two maps of the quadratic family. Many of the interesting features displayed by these systems are discussed.

Dynamics of the logistic map under discrete parametric perturbation

By introducing a periodic perturbation in the control parameter of the logistic map we have investigated the period locking properties of the map. The map then gets locked onto the periodicity of the perturbation for a wide range of values of the parameter and hence can lead to a control of the chaotic regime. This parametrically perturbed map exhibits many other interesting features like the presence of bubble structures, repeated reappearance of periodic cycles beyond the chaotic regime, dependence of the escape parameter on the seed value and also on the initial phase of the perturbation etc.

Bifurcation structure and Lyapunov exponents of a modulated logistic map

We have studied the bifurcation structure of the logistic map with a time dependant control parameter. By introducing a specific nonlinear variation for the parameter, we show that the bifurcation structure is modified qualitatively as well as quantitatively from the first bifurcation onwards. We have also computed the two Lyapunov exponents of the system and find that the modulated logistic map is less chaotic compared to the logistic map.

An analogue of the logistic map in two dimensions

This is a sequel to our earlier work on the modulated logistic map. Here, we first show that the map comes under the universality class of Feigenbaum. We then give evidence for the fact that our model can generate strange attractors in the unit square for an uncountable number of parameter values in the range μ∞<μ<1. Numerical plots of the attractor for several values of μ are given and the self-similar structure is explicity shown in one case. The fractal and information dimensions of the attractors for many values of μ are shown to be greater than one and the variation in their structure is analysed using the two Lyapunov exponents of the system. Our results suggest that the map can be considered as an analogue of the logistic map in two dimensions and may be useful in describing certain higher dimensional chaotic phenomena.

Universal behaviour in a ``modulated'' logistic map

We study the period-doubling bifurcations to chaos in a logistic map with a nonlinearly modulated parameter and show that the bifurcation structure is modified significantly. Using the renormalisation method due to Derrida et al. we establish the universal behaviour of the system at the onset of chaos.

Some Aspects of Domain Specific Conceptual Modeling for Simulation of Logistic Terminal Operations

When simulation modeling is used for performance improvement studies of complex systems such as transport terminals, domain specific conceptual modeling constructs could be used by modelers to create structured models. A two stage procedure which includes identification of the problem characteristics/cluster - ‘knowledge acquisition’ and identification of standard models for the problem cluster – ‘model abstraction’ was found to be effective in creating structured models when applied to certain logistic terminal systems. In this paper we discuss some methods and examples related the knowledge acquisition and model abstraction stages for the development of three different types of model categories of terminal systems

Use of multilevel logistic regression to identify the causes of differential item functioning

Resumen tomado de la publicaci??n

Factores asociados a que usuarias de un hospital público, no soliciten los resultados de citologia cervical

El cáncer de cuello uterino y su mortalidad en Colombia ha permanecido constantes pese a los esfuerzos institucionales, distritales y nacionales que han buscado fortalecer los programas de prevención; sin embargo las estrategias actuales hacen énfasis en la toma de citología y no en la solicitud oportuna del resultado y el tratamiento de la usuaria en caso de anormalidad. METODOLOGIA: Se realizó un estudio en dos fases, un análisis descriptivo se analizaron 12875 y una segunda que involucro 257 pacientes en un análisis de casos y controles de una muestra aleatoria. RESULTADOS: Se utiliza para análisis bivariado la prueba de Chi cuadrado y regresión logística que muestran diferencias significativas en los siguientes variables: la explicación sobre la importancia del examen (p= 0.0060), importancia de la solicitud de resultado (p= 0.003), explicación sobre cuando reclamarlo (p=0.030), distancia entre residencia y centro de salud (p=0.065) DISCUSIÓN: En nuestro estudio se identificó que los factores como el acceso de la paciente al centro de salud, el tiempo del cual dispone para solicitar el resultado, si el dinero con el que cuenta la paciente para desplazarse al hospital, si es la primera vez que se realiza la citología, si le explicaron la importancia de reclamar el resultado y en que lapso de tiempo debía hacerlo, la información que tiene acerca de la importancia de realizarse la citología contribuyen en el hecho de que una paciente de esta población de un hospital público reclame o no su resultado de su citología