Vânia Naomi Hirakata

Bio: Vânia Naomi Hirakata is an academic researcher from Universidade Federal do Rio Grande do Sul. The author has contributed to research in topics: Medicine & Cronbach's alpha. The author has an hindex of 14, co-authored 26 publications receiving 3583 citations. Previous affiliations of Vânia Naomi Hirakata include Universidade Federal de Pelotas & Universidade Federal de Ciências da Saúde de Porto Alegre.

Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio

Abstract: Cross-sectional studies with binary outcomes analyzed by logistic regression are frequent in the epidemiological literature. However, the odds ratio can importantly overestimate the prevalence ratio, the measure of choice in these studies. Also, controlling for confounding is not equivalent for the two measures. In this paper we explore alternatives for modeling data of such studies with techniques that directly estimate the prevalence ratio. We compared Cox regression with constant time at risk, Poisson regression and log-binomial regression against the standard Mantel-Haenszel estimators. Models with robust variance estimators in Cox and Poisson regressions and variance corrected by the scale parameter in Poisson regression were also evaluated. Three outcomes, from a cross-sectional study carried out in Pelotas, Brazil, with different levels of prevalence were explored: weight-for-age deficit (4%), asthma (31%) and mother in a paid job (52%). Unadjusted Cox/Poisson regression and Poisson regression with scale parameter adjusted by deviance performed worst in terms of interval estimates. Poisson regression with scale parameter adjusted by χ2 showed variable performance depending on the outcome prevalence. Cox/Poisson regression with robust variance, and log-binomial regression performed equally well when the model was correctly specified. Cox or Poisson regression with robust variance and log-binomial regression provide correct estimates and are a better alternative for the analysis of cross-sectional studies with binary outcomes than logistic regression, since the prevalence ratio is more interpretable and easier to communicate to non-specialists than the odds ratio. However, precautions are needed to avoid estimation problems in specific situations.

Treating Medication-Resistant Panic Disorder: Predictors and Outcome of Cognitive-Behavior Therapy in a Brazilian Public Hospital

Abstract: Background: In Brazil, treatment of panic disorder is most frequently initiated with pharmacotherapy, but only half of the patients can be expected to be panic free after medication

Obesity and its relationship with asthma prevalence and severity in adolescents from southern Brazil.

Abstract: Obesity has been pointed out as a risk factor for higher prevalence of asthma and asthma-related symptoms in adolescents. The objective was to evaluate the relationship between the prevalence of asthma and obesity in adolescents living in Santa Maria and surroundings (state of Rio Grande do Sul, southern Brazil), applying the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. A total of 4,010 of 6,123 schoolchildren, 13 to 14 years of age, enrolled in the ISAAC phase III protocol (asthma core questionnaire) and were nutritionally evaluated: height, weight, and triceps skinfold (TSF) measurements. Prevalence of asthma (wheeze in the last 12 months) and prevalence of severe asthma (two or more affirmative responses to: more than 4 acute attacks of asthma, speech disturbance, sleep disturbance, wheezing with exercise) were evaluated and compared according to their nutritional status: obese and non-obese. Obese adolescents were defined by body mass index (BMI, in kg/m2) ≥85th percentil...

Análise de concordância entre métodos de Bland-Altman

Abstract: Quando se pretende avaliar a concordância entre dois metodos que deveriam medir a mesma quantidade, sao utilizadas analises que nem sempre estao corretas. E importante que seja evitado o uso da correlacao nestas situacoes e que a metodologia seja utilizada de forma adequada, incluindo os limites de concordância e seus intervalos de confianca, alem de comentar se os limites encontrados sao diferencas aceitaveis do ponto de vista clinico. A proposta do presente artigo e apresentar um metodo bastante simples que ja e utilizado ha bastante tempo, que e a analise de concordância entre metodos de Bland-Altman, salientando alguns problemas detectados na sua utilizacao. Para isto, foi feita uma simulacao de tres diferentes situacoes, com comentarios e solucoes. O programa R, por ser livre e ter incorporado comandos para a analise de Bland-Altman, foi utilizado para a analise dos resultados.

Childhood maltreatment predicts adult inflammation in a life-course study

Abstract: Stress in early life has been associated with insufficient glucocorticoid signaling in adulthood, possibly affecting inflammation processes. Childhood maltreatment has been linked to increased risk of adult disease with potential inflammatory origin. However, the impact of early life stress on adult inflammation is not known in humans. We tested the life-course association between childhood maltreatment and adult inflammation in a birth cohort followed to age 32 years as part of the Dunedin Multidisciplinary Health and Development Study. Regression models were used to estimate the effect of maltreatment on inflammation, adjusting for co-occurring risk factors and potential mediating variables. Maltreated children showed a significant and graded increase in the risk for clinically relevant C-reactive protein levels 20 years later, in adulthood [risk ratio (RR) = 1.80, 95% confidence interval (CI) = 1.26–2.58]. The effect of childhood maltreatment on adult inflammation was independent of the influence of co-occurring early life risks (RR = 1.58, 95% CI = 1.08–2.31), stress in adulthood (RR = 1.64, 95% CI = 1.12–2.39), and adult health and health behavior (RR = 1.76, 95% CI = 1.23–2.51). More than 10% of cases of low-grade inflammation in the population, as indexed by high C-reactive protein, may be attributable to childhood maltreatment. The association between maltreatment and adult inflammation also generalizes to fibrinogen and white blood cell count. Childhood maltreatment is a previously undescribed, independent, and preventable risk factor for inflammation in adulthood. Inflammation may be an important developmental mediator linking adverse experiences in early life to poor adult health.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Abstract: SummaryIn this report, recommendations for the pharmacological treatment of anxiety and obsessive-compulsive disorders are presented, based on available randomized, placebo-or comparator-controlled

Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology

Abstract: These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.