Carla Moreira

Retrospective cohort aimed to analyze viral resistance mutations to integrase in people living with HIV/Aids (PLWHA) in Brazil. Patients receiving first-line therapy with a three-drug antiretroviral (ART) regimen containing dolutegravir (DTG), with HIV-1 genotypic resistance test available after starting treatment, were included. Data from three national databases related to antiretroviral dispensing, LT CD4+ cell count and HIV viral load (VL), and genotyping resistance testing were linked. Ideal adherence was defined as the proportion of days covered (PDC) ≥ 80%. Thirty (7.0%) of the 430 participants had resistance to DTG; five had high and 11 had moderate resistance levels. The N155H (n = 9) and E138K (n = 7) mutations were the most prevalent. DTG mutations were significantly more prevalent among males, whites, and those with HIV-VL count > 100,000 copies/mL, switching to alternative regimens or with resistance mutations to other classes of antiretroviral drugs (p < 0.05). Ideal ART adherence was observed in 52.8% of the participants and it was associated with DTG mutations (p < 0.001). This study described the resistance mutations to DTG in individuals starting treatment with this drug and the characteristics of such individuals. Understanding such a profile is crucial to regions where a DTG-containing regimen is the recommended first-line therapy.

The normal distribution (bell curve or Gaussian distribution) is a distribution that happens commonly in many circumstances. Real-life data rarely, if ever, follow a perfect normal distribution. Many tests are useful to test normality and more particularly skewness and kurtosis tests assess the comparability of a given distribution from a normal distribution. These tests are widely used in statistics, business, and epidemiological data including blood pressure, heights, IQ scores and measurement errors. This report provides a review assessing the essential methods employed for testing normality and highlighting the importance of skewness and Kurtosis in statistics. Moreover, it gives some examples of the importance of normality in epidemiological health studies analysis.

(1) Background: In an ageing society, social relationships may benefit cognitive performance with an impact on the health of older people. This study aims to estimate the effect of different social support sources on the risk of cognitive impairment in a sample of older Portuguese people. (2) Methods: From the Portuguese EpiPorto cohort study, we followed a sample of participants with 60 to 85 years (N = 656) between 2009 and 2015 (4.63 mean years of follow-up). The participants’ perception of social support from family, friends and significant others was evaluated. Cox’s regression models were used to investigate the association between this and sociodemographic variables. (3) Results: It was found that social support from friends reduces the risk of cognitive impairment. Men, participants aged 60 to 64 and those not married have a lower risk of cognitive impairment after adjusting for other variables. Participants between 80 and 85 years old (p = 0.021), those with less than four years of education (p < 0.001), and those with cognitive impairment (p = 0.007) have perception of less social support from friends. (4) Conclusions: A social support network from friends reduces the risk of cognitive impairment for older people.

The NPMLE of a distribution function from doubly truncated data was introduced in the seminal paper of Efron and Petrosian. The consistency of the Efron-Petrosian estimator depends however on the assumption of independent truncation. In this work we introduce an extension of the Efron-Petrosian NPMLE when the variable of interest and the truncation variables may be dependent. The proposed estimator is constructed on the basis of a copula function which represents the dependence structure between the variable of interest and the truncation variables. Two different iterative algorithms to compute the estimator in practice are introduced, and their performance is explored through an intensive Monte Carlo simulation study. We illustrate the use of the estimators on two real data examples.

Background: Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across the life-course. Methods: This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by forced expiratory volume in 1 s (FEV ₁ ) and forced vital capacity (FVC). 70 496 participants (51% female) aged 18–93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level) and adulthood (low occupational position). Risk factors for poor lung function ( e.g. smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage. Results: Socioeconomic disadvantage during the life-course was associated with a lower FEV ₁ . By the age of 45 years, individuals experiencing disadvantaged socioeconomic conditions had lost 4–5 years of healthy lung function versus their more advantaged counterparts (low educational level −4.36 (95% CI −7.33–−2.37) for males and −5.14 (−10.32–−2.71) for females; low occupational position −5.62 (−7.98–−4.90) for males and −4.32 (−13.31–−2.27) for females), after accounting for the risk factors for lung function. By the ages of 65 years and 85 years, the years of lung function lost due to socioeconomic disadvantage decreased by 2–4 years, depending on the socioeconomic indicator. Sensitivity analysis using FVC yielded similar results to those using FEV ₁ . Conclusion: Life-course socioeconomic disadvantage is associated with lower lung function and predicts a significant number of years of lung function loss in adulthood and at older ages.

After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011–2012), we included 607 women with a singleton pregnancy and PPROM at 24–29 weeks’ gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes.

Childhood obesity estimates are steadily increasing worldwide. There is strong evidence that overweight children before puberty maintain this nutritional status for life. This study aimed to estimate the prevalence and incidence rates of overweight and obesity among children recruited as part of the Generation XXI birth cohort. Of the 8036 included children, 5497, 5397 and 4956 of them had follow-up measurements at 4, 7 and 10 years of age, respectively. The chi-square test, Student’s t-test, and survival curves were estimated according to sex. The prevalence of overweight remained stable at 4 and 7 years of age (22.0% and 22.1%, respectively) and slightly increased at age 10 (26.1%). Conversely, obesity prevalence increased with age (from 10.6 to 16.8%). Overweight was more prevalent in girls at all follow-ups, whilst obesity was similar between sexes at ages 4 and 7 (p = 0.050 and p = 0.218, respectively) but was more prevalent in boys at age 10 (p = 0.017). The incidence of obesity between 4 and 7 years of age was 11.4/1000 person-years, decreasing to 3.2/1000 person-years between 7 and 10 years of age. Our results reveal a high prevalence/incidence of obesity mainly among 4 and 7-year-old children, heightening the need for interventions at early ages to effectively curb childhood obesity in Portugal.

: Weight management strategies during pregnancy reduce child cardiometabolic risk. However, because maternal weight has an overall positive correlation with offspring bone mass, pregnancy weight management could adversely affect child bone health. We aimed to estimate associations between gestational weight gain (GWG) and bone mineralization in the offspring at 7 years of age, and test early pregnancy body mass index (BMI) as an effect modifier. We analyzed prospective data from 2167 mother-child pairs from the Generation XXI birth cohort who underwent whole-body dual-energy X-ray absorptiometry at 7 years of age. GWG was analyzed as a continuous measure and using the Institute of Medicine categories. In the whole sample and for each early pregnancy BMI category (under/normal weight and overweight/obese), relationships between GWG and offspring bone measures (bone mineral content [BMC], bone areal density [aBMD], size-corrected BMC [scBMC], and height) at 7 years were fitted through local polynomial regression and smoothing splines. The magnitude of associations was estimated through linear regression coefficients (95% CIs), crude and adjusted for maternal age, height, educational level, and child gestational age. In under/normal weight mothers, GWG was associated with slightly increased bone measures at 7 years (per 5 kg of GWG, BMC: 0.07 SD [95% CI, 0.01 to 0.12]; aBMD: 0.10 SD [95% CI, 0.05 to 0.15], scBMC: 0.11SD [95% CI, 0.06 to 0.16], and height: 0.05 SD [95% CI, 0.00 to 0.10]), while in overweight/obese mothers no effect of GWG on bone was observed (BMC: 0.02 SD [95% CI, –0.04 to 0.09]; aBMD: 0.02 SD [95% CI, –0.04 to 0.08], scBMC: 0.01 SD [95% CI, –0.06 to 0.08], and height: 0.02 SD [95% CI, –0.04 to 0.08]). Also, no advantageous effect of gaining weight above the Institute of Medicine recommendations was observed in either early pregnancy BMI group. Our results suggest that adherence to Institute of Medicine recommendations for pregnancy weight gain is unlikely to have a negative repercussion on offspring bone health, particularly in women with excess weight in early pregnancy. © 2018 American Society for Bone and Mineral Research.