CURSO DE MEDICINA

Escola de Saúde – UNISINOS

ATIVIDADE ACADÊMICA: Metodologia Científica
Ano/Sem: 2022/1 Professora: Dra. Tonantzin Gonçalves (T1)

EXERCÍCIOS – ESTUDOS QUANTITATIVOS

1. Leia os resumos, identifique e avalie criticamente:

a) Tipo de estudo/delineamento;
b) Questão de pesquisa;
c) Possíveis vieses/limitações;
d) Resultados principais e conclusões.

RESUMO 1: doi: 10.4088/JCP.18m12532

OBJECTIVE: This study analyzed past 12-month disorder-specific mental health treatment patterns of common
DSM-5 disorders in the United States. METHODS: Nationally representative face-to-face household survey
data from structured diagnostic interviews of the 2012-2013 National Epidemiologic Survey on Alcohol and
Related Conditions-III (NESARC-III) (n = 36,309) were used to estimate percentages of respondents with 12-
month DSM-5 mood, anxiety, and substance use disorders who received disorder-specific treatment during the
12 months before the interview. RESULTS: The percentage receiving treatment was highest for
mood disorders (37.8%; 95% CI, 36.1%-39.6%), followed by anxiety disorders (24.1%; 95% CI, 22.6%-25.6%),
and lowest for substance use disorders (18.8%; 95% CI, 17.8%-19.8%). Among anxiety disorders, panic
disorder (47.9%; 95% CI, 43.9%-52.0%) had the highest treatment rate, and among substance use disorders,
tobacco use disorder (20.3%; 95% CI, 19.0%-21.7%) had the highest treatment rate. Adults with mood and
anxiety disorders (53.1%; 95% CI, 49.7%-56.4%) were more likely than those with only mood (32.0%; 95% CI,
29.5%-34.6%) or only anxiety (13.2%; 95% CI, 11.6%-15.0%) disorders to receive any mental health treatment.
Lack of insurance coverage was associated with significantly lower odds of treatment for all disorders except
specific phobia (0.55; 95% CI, 0.30-1.03), drug use disorders other than tobacco (0.80; 95% CI, 0.47-1.36), and
alcohol use disorder (1.52; 95% CI, 1.12-2.07). CONCLUSIONS: Most adults with common mental disorders in
the United States were not treated for their disorders, and treatment rates varied considerably
across disorders and sociodemographic groups, with particularly low rates of treatment for substance
use disorders. Policy and clinical interventions are needed to promote greater access to treatment of adults with
common substance use, anxiety, and mood disorders.

RESUMO 2: DOI: 10.1056/NEJMoa1203366

Background: The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members
themselves and the medical team remains controversial. Methods: We enrolled 570 relatives of patients who
were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were
randomly assigned either to systematically offer the family member the opportunity to observe CPR
(intervention group) or to follow standard practice regarding family presence (control group). The primary end
point was the proportion of relatives with post-traumatic stress disorder (PTSD)–related symptoms on day 90.
Secondary end points included the presence of anxiety and depression symptoms and the effect of family
presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of
medicolegal claims. Results: In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared
with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-
related symptoms was significantly higher in the control group than in the intervention group (adjusted odds
ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness
CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not
witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR.
Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional
stress in the medical team and did not result in medicolegal claims. Conclusions: Family presence during CPR
was associated with positive results on psychological variables and did not interfere with medical efforts,
increase stress in the health care team, or result in medicolegal conflicts.

RESUMO 3: DOI: 10.1007/s15010-020-01566-6

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has spread to all countries in the world, and
different countries have been impacted differently. The study aims to understand what factors contribute to
different COVID-19 impacts at the country level. Methods: Multivariate statistical analyses were used to
evaluate COVID-19 deaths and cases relative to nine other demographic and socioeconomic factors in all
countries and regions of the world using data as of August 1, 2020. The factors analyzed in the study include a
country's total COVID-19 deaths and cases per million population, per capita gross domestic product (GDP),
population density, virus tests per million population, median age, government response stringency index,
hospital beds availability per thousand population, extreme poverty rate, Bacille Calmette-Guérin (BCG)
vaccination rate, and diphtheria-tetanus-pertussis (DTP3) immunization rate. Results: The study reveals that
COVID-19 deaths per million population in a country most significantly correlates, inversely, with the country's
BCG vaccination rate (r = - 0.50, p = 5.3e-5), and also significantly correlates a country's per capita GDP (r =
0.39, p = 7.4e-3) and median age (r = 0.30, p = 0.042), while COVID-19 cases per million population
significantly correlate with per capita GDP and tests per thousand population. To control for possible
confounding effects of age, the correlation was assessed in countries propensity score matched for age. The
inverse correlation between BCG vaccination rates and COVID-19 case (r = - 0.30, p = 0.02) and death (r = -
0.42, p = 0.0007) remained significant among the top 61 countries with the highest median age. Conclusion:
This study contributes to a growing body of evidence supporting the notion that BCG vaccination may be
protective against COVID-19 mortality.

RESUMO 4: doi: 10.1590/S1413-81232011000500011

O presente estudo tem como objetivo verificar a associação entre a distribuição da gordura corporal e o câncer
de mama em mulheres do Rio Grande do Sul. Para este estudo, utilizou- se um delineamento de caso-controle,
no qual foram avaliadas cem mulheres com diagnóstico histopatológico de câncer de mama em comparação
com o grupo controle ambulatorial (400 mulheres) durante os meses de janeiro a outubro de 2005. As
variáveis antropométricas coletadas foram: massa corporal (kg), estatura, circunferência da cintura (CC) e
perímetro do quadril. Não foi encontrada associação entre o índice de massa corporal (IMC) e a razão
cintura/quadril (RCQ) com ocorrência de câncer de mama. Já para CC, observou-se que mulheres com essa
medida elevada (> 88 cm) apresentam 2,08 vezes mais chance de desenvolver a doença do que aquelas com as
medidas normais ou moderadas (< 80 cm-87 cm). Quando essas mulheres foram agrupadas por estado
menopausal (pré e pós) e variáveis antropométricas, somente a CC apresentou associação OR ajustado=3,15.
Conclusão: acúmulo de gordura na parte superior do corpo (CC > 88 cm) é um preditor de câncer de mama
especialmente em mulheres pré-menopausa.

EXERCÍCIO DE INTERPRETAÇÃO DE RESULTADOS - Observe a Tabela a seguir que

descreve características gerais dos participantes da coorte de idosos de Bambuí e responda as
questões:
1. Quais são as variáveis nominais (ou qualitativas) e as variáveis numéricas (ou quantitativas)
descritas na primeira coluna da tabela?
2. Existem diferenças entre homens e mulheres no que se refere as variáveis estudadas? Explique
sua resposta.