Medicine, Uruguay
Medicine, Uruguay

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van Schaik G.,Epidemiology Group
Preventive Veterinary Medicine | Year: 2013

At the end of 2007, the first year of what later turned out to be one of the largest Q fever outbreaks in the world with ultimately almost 3500 human patients notified in three years time, dairy goats were suspected to be the possible cause. However, current information on the Q fever prevalence in small ruminants in The Netherlands was lacking.A serological survey, using an indirect ELISA, was carried out in 15,186 sheep and goats in The Netherlands in 2008. In total, 2.4% (95% CI: 2.2-2.7) of the sheep and 7.8% (95% CI: 6.9-8.8) of the goats was seropositive for antibodies against Coxiella burnetii. In 14.5% (95% CI: 12.5-16.5) of the sheep flocks and 17.9% (95% CI: 14.2-21.5) of the goat herds at least one seropositive animal was found. In sheep flocks with at least one seropositive sheep, the within herd seroprevalence was 14.8% (95% CI: 12.6-17.0). In goat herds with at least one seropositive goat, the within herd seroprevalence was 29.0% (95% CI: 24.6-33.3).The seropositive sheep were equally distributed across the country. The seroprevalence in goats in the south-eastern part of The Netherlands, the area where most of the human Q fever cases were notified, was significantly higher than the seroprevalence in goats in the rest of The Netherlands. Dairy sheep and dairy goats had a significantly higher chance of being seropositive than non-dairy sheep and goats. During pregnancy and in the periparturient period, small ruminants tested significantly more often seropositive than in the early- or non-pregnant period.The seroprevalence as well as the true prevalence among small ruminants in The Netherlands were lower than prevalences reported elsewhere. The seroprevalence among sheep was also lower than reported in an earlier Dutch study in 1987. The Q fever seroprevalence was highest in pregnant and periparturient dairy goats in the south-eastern part of The Netherlands, which coincides with the region with the highest human incidence of Q fever. © 2012 Elsevier B.V..


Mendilaharsu M.,Epidemiology Group | Boffetta P.,Mount Sinai School of Medicine | Deneo-Pellegrini H.,Epidemiology Group | de Stefani E.,Epidemiology Group
Asian Pacific Journal of Cancer Prevention | Year: 2014

In the time period 1996-2004, all incident cases of bladder cancer were included in a case-control study in order to study the role of meat consumption and product animals in the etiology of urothelial cancer. The study included 225 cases and 1,510 hospitalized controls with non-neoplastic conditions, not related to smoking and alcohol drinking. Relative risks, approximated by the odds ratios, were calculated in order to clarify the effect of meat consumption in the etiology of urothelial cancer. Total meat consumption (OR 1.47, 95% CI 1.02-2.11), total processed meat (OR 1.57, 95% CI 1.08-2.27), frankfurters (hot dogs) (OR 2.03, 95% CI 1.28-3.21), ham (OR 1.79, 95% CI 1.21-2.67) and salted meat (OR 2.73, 95% CI 1.78-4.18) were positively associated with risk of bladder cancer. Animal products, like cheese, whole milk, and total eggs were also associated with bladder cancer risk (OR for eggs 4.05, 95% CI 2.68-6.12). In conclusion, total meat, processed meat, and eggs could play an important role in the etiology of bladder cancer in Uruguay.


Rolim D.B.,University of Fortaleza | Vilar D.C.F.L.,Epidemiology Group | De Goes Cavalcanti L.P.,Federal University of Ceará | Freitas L.B.N.,Federal University of Ceará | And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

A seroepidemiological investigation was conducted among the population of two municipalities in Northeastern Brazil. Immunoglobulin M (IgM) and IgG antibodies to Burkholderia pseudomallei were positive in 51.27% (161 in 317 samples) and 58.49% (186), respectively. IgM titers were higher in children than in adults. On the contrary, IgG increased progressively with age. We observed a significant association between agricultural occupation and raised IgM titers (P < 0.005) and IgG titers (P < 0.001), and between construction workers and raised IgG titers (P = 0.005). Antibody IgG avidities did not correlate with age. The highest titers of antibodies (1/800) showed the highest antibody avidity indexes (P < 0.01). Most of the serum samples recognized 45-kDa and 200-kDa bands by IgG1 and IgG2 subclasses. Our study showed a high seropositivity among individuals living in endemic regions of the state of Ceara´, and highlights the need for further surveillance close to water courses such as dams and rivers in Northeastern Brazil. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.


Ronco A.L.,Pereira Rossell Womens Hospital | De Stefani E.,Epidemiology Group | Deneo-Pellegrini H.,Epidemiology Group | Quarneti A.,Pereira Rossell Womens Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2012

Obese postmenopausal women increase their risk of developing breast cancer (BC), in particular if they display an android-type pattern of adiposity, which is also associated to increased risks of diabetes mellitus, hypertension and cardiovascular disease. In order to explore the associations among anthropometry (body mass index, body composition, somatotype), some specific items of medical history (diabetes, hypertension, dislypidemias, hyperuricemia) and the risk of BC in Uruguayan women, a case-control study was carried out between 2004-2009 at our Oncology Unit. 912 women of ages between 23-69 years (367 new BC cases and 545 non hospitalized, age-matched controls with a normal mammography) were interviewed. Twenty body measurements were taken in order to calculate body composition and somatotype. Patients were queried on socio-demographics, reproductive history, family history of cancer, a brief food frequency questionnaire and on personal history of diabetes, dislypidemias, hyperuricemia, hypertension and gallbladder stones. Uni- and multivariate analyses were done, generating odds ratios (ORs) as an expression of relative risks. A personal history of diabetes was positively associated to BC risk (OR=1.64, 95% CI 1.00-2.69), being higher among postmenopausal women (OR=1.92, 95% CI 1.04-3.52). The risks of BC for diabetes in postmenopausal women with overweight combined with dislypidemia (OR=9.33, 95% CI 2.10-41.5) and high fat/muscle ratio (OR=7.81, 95% CI 2.01-30.3) were significantly high. As a conclusion, a personal history of diabetes and overweight was strongly associated to BC. The studied sample had a subset of high-risk of BC featured by postmenopausal overweight and diabetic women, who also had a personal history of hypertension and/or dyslipidemia. The present results could contribute to define new high risk groups and individuals for primary as well as for secondary prevention, since this pattern linked to the metabolic syndrome is usually not considered for BC prevention.


PubMed | Health Improvement Branch Australian Capital Territory Health Directorate, University of Canberra and Epidemiology Group
Type: Journal Article | Journal: BMJ open | Year: 2016

To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs.A cross-sectional analysis of public hospital episode data (2007-2013).Hospitalisations from the ACT, Australia at very small geographic areas.Secondary data on 75290 unique hospital episodes representing 39851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity.Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability.Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers.Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers.Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.


PubMed | GD Animal Health Service and Epidemiology Group
Type: Journal Article | Journal: Veterinary microbiology | Year: 2014

In November 2011, the new orthobunyavirus Schmallenberg virus (SBV) was identified in dairy cows that had induced fever, drop in milk production and diarrhoea in the Netherlands (Muskens et al., 2012. Tijdschrift voor Diergeneeskunde 137, 112-115) and a drop in milk production in cows in Northwestern Germany (Hoffmann et al., 2012. Emerging Infectious Diseases 18 (3), 469-472), in August/September 2011. This study aimed at quantifying risk factors for high within-herd prevalence of SBV and SBV-induced malformations in newborn calves in dairy herds in the Netherlands. Additionally, the within-herd impact of SBV infection on mortality rates and milk production was estimated. A case-control design was used, including 75 clinically affected case herds and 74 control herds. Control herds were selected based on absence of malformations in newborn calves and anomalies in reproductive performance. SBV-specific within-herd seroprevalences were estimated. Risk factors for high within-herd SBV seroprevalence (>50%) and the probability of malformed newborn calves in a herd were quantified. In addition, within-herd impact of SBV with regard to milk production and mortality was estimated. Animal-level seroprevalence was 84.4% (95% confidence interval (CI): 70.8-92.3) in case herds and 75.8% (95% CI: 67.5-82.5) in control herds. Control herds that were completely free from SBV were not present in the study. Herds that were grazed in 2011 had an increased odds (OR 9.9; 95% CI: 2.4-41.2)) of a high seroprevalence (>50%) compared to herds that were kept indoors. Also, when grazing was applied in 2011, the odds of malformations in newborn calves tended to be 2.6 times higher compared to herds in which cattle were kept indoors. Incidence of malformations in newborn calves at herd level was associated with both within-herd seroprevalence and clinical expression of the disease in adult cattle. The rate of vertical transmission of SBV to the fetus once a dam gets infected seemed low. A total of 146 stillborn or malformed calves were submitted by 65 farmers during the study period, of which 19 were diagnosed as SBV-positive based on pathological investigation and/or RT-qPCR testing of brain tissue. Based on these results combined with calving data from these herds we roughly estimated that at least 0.5% of the calves born between February and September 2012 have been infected by SBV. A drop in milk production was observed between the end of August 2011 and the first half of September (week 35-36), indicating the acute phase of the epidemic. During a 4-week period in which SBV infection was expected to have occurred, the total loss in milk production in affected dairy herds was around 30-51 kg per cow. SBV had no or limited impact on mortality rates which was as expected given the relatively mild expression of SBV in adult cows and the low incidence of malformations in newborn calves.


Deneo-Pellegrini H.,Epidemiology Group | Boffetta P.,Mount Sinai School of Medicine | De Stefani E.,Epidemiology Group | Correa P.,Vanderbilt University | And 5 more authors.
Cancer Causes and Control | Year: 2013

Objective The aim of this study was to investigate the association between nutrient-based dietary patterns and squamous cell cancers of the head and neck. Methods We used a case-control study which included 548 cases and 548 controls. From these participants, we derived 23 nutrients and they were then submitted to a factorability analysis in order to conduct a principal component factor analysis. Results We were able to identify four nutrient-derived patterns. The first pattern (meat-based pattern) was positively associated with squamous cell cancer of the head and neck (OR 2.85, 95 % CI 1.81-4.15), whereas the third pattern (fruit-based) was strongly protective (OR 0.43, 95 % CI 0.27-0.63). The other nutrient patterns were also significantly associated with head and neck squamous cell carcinoma with minor ORs. Conclusion Both patterns suggest that red meat and fruits are major factors in the etiology of head and neck squamous cell cancer, replicating previous studies in the field. © Springer Science+Business Media Dordrecht 2013.


PubMed | University of New South Wales, Ingham Institute of Applied Science and Epidemiology Group
Type: | Journal: The Australian & New Zealand journal of obstetrics & gynaecology | Year: 2016

Glycated haemoglobin (HbA1c) is an important tool for assessing glycaemic status in patients with diabetes, but its usefulness in gestational diabetes mellitus (GDM), is unclear.The aim of this study is to evaluate whether HbA1c in women with GDM is valuable in predicting adverse pregnancy outcomes.A retrospective review of women with GDM who had HbA1c measured at diagnosis of GDM (GHb-diag) and at 36 weeks gestation (GHb-36 weeks) was conducted. The association between HbA1c and various pregnancy outcomes was assessed RESULTS: Among 1244 women with GDM in our cohort, both GHb-diag and GHb-36 weeks were independent predictors for large-for-gestation (LGA) babies (OR 1.06, P = 0.005 and OR 1.06, P = 0.002, respectively) and neonatal hypoglycaemia (OR 1.10, P < 0.001 and OR 1.09, P < 0.001, respectively). Women with HbA1c 5.4% (35 mmol/mol) at diagnosis had significantly greater risk for LGA (15.3% vs 8.2%, P < 0.001) and neonatal hypoglycaemia (42.2% vs 23.6%, P < 0.001) than those below this cut-off. The difference between GHb-diag and GHb-36 weeks was small and improvement in HbA1c by 36 weeks was not associated with better pregnancy outcomes.We showed that measurement of HbA1c, either at the time of diagnosis of GDM or toward the end of pregnancy, were both associated with adverse pregnancy outcomes. Women with elevated HbA1c (>5.4% or 35 mmol/mol) at diagnosis of GDM should be monitored closely during pregnancy. However, there is not enough evidence to suggest that repeating HbA1c toward the end of pregnancy will provide additional information in predicting adverse pregnancy outcomes.


PubMed | South Western Sydney Local Health District, University of New South Wales, Epidemiology Group, La Trobe University and 4 more.
Type: Journal Article | Journal: BMJ open | Year: 2016

To determine the amount of daily screen time in children 18months of age and ascertain correlations that may be contributing to excessive screen use.A birth cohort was followed with telephone interviews at 6, 12 and 18months of age. Information about screen time was collected at 18months.Parents were recruited from postnatal wards of 2 major public hospitals and at home visits conducted for new mothers within 4weeks of birth in South Western Sydney (SWS).Parents of 500 children with infants 18months of age residing in SWS.Screen time in infants 18months of age and associated correlations.A large percentage of children 18months of age (40%) had screen times >2hours daily. There were significant associations between more than 2hours of screen time daily and mothers without a partner (OR 4.32 (95% CI 1.67 to 11.15)); having <3 siblings (no siblings: OR 2.44 (95% CI 1.20 to 4.94); 1-2 siblings: OR 2.08 (95% CI 1.06 to 4.08)); an employed father (OR 1.96 (95% CI 1.09 to 3.52)); no outdoor equipment at home (OR 1.89 (95% CI 1.08 to 3.34)) and fewer than 5 outings per week (OR 2.08 (95% CI 1.37 to 3.17)).There is emerging evidence that excess screen time in children causes adverse cognitive, developmental and health outcomes. This study has shown that a large proportion of very young children residing in SWS have screen exposures for >2hours per day. Factors contributing to excess screen time have also been identified in this study; however, a greater understanding of risk factors needs to be ascertained in order to facilitate greater public health efforts to reduce screen exposure.


The role of meat in squamous cell carcinoma of the esophagus (ESCC) has been considered conflictive. For this reason, we decided to conduct a case-control study on meat consumption and ESCC. Data included 234 newly diagnosed and microscopically examined ESCC and 2,020 controls with conditions not related to tobacco smoking nor alcohol drinking and without changes in their diets. We studied total meat, red meat, beef, lamb, processed meat, poultry, fish, total white meat, liver, fried meat, barbecued meat, boiled meat, heterocyclic amines, nitrosodimethylamine, and benzo[a]pyrene in relation with the risk of ESCC. Red meat, lamb, and boiled meat were directly associated with the risk of ESCC, whereas total white meat, poultry, fish, and liver were mainly protective against this malignancy.

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