Documente Academic
Documente Profesional
Documente Cultură
2018
Pedro Aravena
Facultad de Medicina UACh
Doctor en Ciencias Médicas
www.drpedroaravena.cl/acerca-del-dr-aravena
OBJETIVOS
EFINIR
• Describir estudios Casos y Controles
• Describir los estudios de Cohorte
• Analizar las medidas de riesgo
• Describir aplicaciones en Odontología
‣ Reportes de caso
Descriptivos ‣ Series de caso
¿quién enferma? ‣ Prevalencia
Estudios
In vitro ‣ Células
Estudios
experimentales ‣Animales
In vivo ‣ Humanos: Clínicos
?
Postulados de Hill (1965)
VALIDEZ INTERNA
1.Fuerza de la asociación
2.Consistencia de asociación
3.Especificidad
4.Secuencia temporal
COHERENCIA CIENTÍFICA
1.Gradiente biológico (dosis-respuesta)
2.Plausibilidad biológica
3.Coherencia historia natural y biológia
4.Evidencia experimental
5.Analogía (asociaciones similares)
The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine.
Caso y controles
Pedro Aravena
Facultad de Medicina UACh
Doctor en Ciencias Médicas
Tiempo
GRUPO CASO
Enfermos
POBLACIÓN
GRUPO CONTROL
No enfermos
Estudio de caso y controles
GRUPO CASO
MALALHUE, 2018
Con parto prematuro
GRUPO CONTROL
Cerda LJ & Valdivia CG. Revista chilena de Infectología. 2007: 24(4); 331-334
Cerda LJ & Valdivia CG. Revista chilena de Infectología. 2007: 24(4); 331-334
Estudio de caso y controles
• Económicos
I. Pregunta de investigación
respuesta
con
a b
periodontits axd
sin bxc
c d
periodontitis
Parto prematuro
+ -
con 250 a 120 b
Periodontitis
Sin 53 c 302 d
a/c b/d
4,71 0,39
axd 75500
OR
bxc 6360
11,8
Sano
Enfermo
Sano
Enfermo
población
Cohorte
• Establece incidencia
• Indica causalidad
• De acuerdo al tiempo
• Prospectivos
• Retrospectivos
• Ambispectivos
• Cohorte de comparación
• Cohorte interna
• Cohorte externa
• Flujo de los pacientes
• Fijos
• Dinámicos
Cohorte retrospectivo
variable respuesta
Con Sin
variable exposición
Incidencia
periodontitis Periodontitis
Cigarrillo a b a/a+b
RESEARCH REPORTS
Clinical
ABSTRACT INTRODUCTION
Objetivo: Calcular la asociación entre carga bacteriana
Objective: To calculate the association of maternal
debeensaliva
observedde 243
madres (del embarazo a 24 meses M ultiple intergenerational
salivary bacterial challenge (mutans streptococci connections have
post-parto) e incidencia de caries de
between mater-
nal conditions and child health outcomes: from body mass index (Murrin
[MS] and lactobacilli [LB]) from pregnancy through
24 months’ postpartum with child caries incidence
et al., 2012) to age of menarche (Deardorff et al., 2012). Consequently, poor
niños (≥1 con carieshealth
o restaurado)
( 1 cavitated or restored teeth) at 36 months.
a
may be transmitted from
Materials & Methods: Dental, salivary bacterial, los 36
parents meses
to children, conceivably perpetuating
health disparities and providing reason to consider intergenerational determi-
sociodemographic, and behavioral measures were
collected at three- to six-month intervals from a birth
nants in disease prevention.
cohort of low-income Hispanic mother-child dyads Correlations between parental and offspring caries status were recognized
(N = 243). We calculated the relative child caries at least as early as the 1940s (Klein, 1946). Cross-sectional (Sasahara et al.,
incidence, adjusted for confounding, following higher 1998; Weintraub CHAFFEE
et al., 2010;BW
Dyeet etal.al.,
J Dent Res
2011) and93(3):238-244, 2014
longitudinal (Grytten
maternal challenge of MS (>4500 colony-forming et al., 1988; Thitasomakul et al., 2009; Shearer et al., 2012) studies have since
93(3) 2014 Maternal Oral Bacterial Levels 241
covariate data (1% of all maternal MS ± 95% CI, children with caries
e addressed with multiple
A 100,000 maternal MS ± 95% CI, children without caries
75,000 mean maternal MS during study, children with caries
Point estimates were aver- mean maternal MS during study, children without caries
0 imputations. We used non- 50,000
bootstrap resampling (5000
1000
Baseline 4 9 12 24 36
udy participants (N = 243 (pregnancy)
d dyads) were primarily from Follow-up Visit (months)
242
Mexican American families Chaffee et al. J Dent Res 93(3) 2014
mong mothers, caries experi- maternal LB ± 95% CI, children with caries
universal Table
(100% 2. Child B
Caries Incidence
baseline 5000
(d2ft > 0) at maternal
36 MonthsLB ±by
95% CI, children
Higher without
versus Lowercaries
Mean Maternal Salivary Bacterial Challenge (N = 243)
mean maternal LB during study, children with caries
), and persistent active caries mean maternal LB during study, children without caries
2500
nt (58% with untreated decay Exposurea: Maternal Mean MS >4500 CFU/mL Exposurea: Maternal Mean LB >50 CFU/mL
). There was no statistically
Model Cumulative Incidence Ratio 95% Confidence Interval Cumulative Incidence Ratio 95% Confidence Interval
ssociation of any Table 1 vari- 1000
Maternal salivary lactobacilli
with postenrollment
Adjusted modelloss to
1 c 500 1.7 1.1, 2.6 1.2 0.8, 1.8
At 36 months,Adjusted
34% of model
children
2d 1.8 1.2, 2.9 1.3 0.9, 1.9
positive (d2ftAdjusted
> 0), including
model 3 e 250 1.7 1.1, 2.8 1.2 0.8, 1.8
ntreated decay (Table 1), while
% of childrenAbbreviations: CFU/mL, colony-forming units per milliliter saliva; d2ft, decayed (cavitated) filled primary tooth index; LB, lactobacilli; MS, mutans
were positive for 100
streptococci.
, respectively.aMean maternal bacterial levels from 75 baseline (in pregnancy) to 24 months’ postpartum.
h MS and LB, b maternal
Includes sali- status from nesting
allocation 50 intervention study only. CHAFFEE BW et al. J Dent Res 93(3):238-244, 2014
ial levels—atc
each visit
Includes and status from nesting intervention study and maternal education, language spoken at home, family structure, household income,
allocation
Halabí D et al. J Oral Maxillofac Surg 2012;70(5):1040–1044
Lazcano-Ponce E. et al. Salud pública Méx 2001;43(2):135-150
Basic Epidemiology, 2nd Edition, R.Bonita
Basic Epidemiology, 2nd Edition, R.Bonita
CONCUSION