JULIANA YUKARI KODAIRA VISCONDI
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
5 resultados
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- Effect of Physical Inactivity on Major Noncommunicable Diseases and Life Expectancy in Brazil(2015) REZENDE, Leandro Fornias Machado de; RABACOW, Fabiana Maluf; VISCONDI, Juliana Yukari Kodaira; LUIZ, Olinda do Carmo; MATSUDO, Victor Keihan Rodrigues; LEE, I-MinBackground: In Brazil, one-fifth of the population reports not doing any physical activity. This study aimed to assess the impact of physical inactivity on major noncommunicable diseases (NCDs), all-cause mortality and life expectancy in Brazil, by region and sociodemographic profile. Methods: We estimated the population attributable fraction (PAF) for physical inactivity associated with coronary heart disease, type 2 diabetes, breast cancer, colon cancer, and all-cause mortality. To calculate the PAF, we used the physical inactivity prevalence from the 2008 Brazilian Household Survey and relative risk data in the literature. Results: In Brazil, physical inactivity is attributable to 3% to 5% of all major NCDs and 5.31% of all-cause mortality, ranging from 5.82% in the southeastern region to 2.83% in the southern region. Eliminating physical inactivity would increase the life expectancy by an average of 0.31 years. This reduction would affect mainly individuals with >= 15 years of schooling, male, Asian, elderly; residing in an urban area and earning >= 2 times the national minimum wage. Conclusions: In Brazil, physical inactivity has a major impact on NCDs and mortality, principally in the southeastern and central-west regions. Public policies and interventions promoting physical activity will significantly improve the health of the population.
- Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil(2016) SARTORI, Ana Marli Christovam; SOAREZ, Patricia Coelho de; FERNANDES, Eder Gatti; GRYNINGER, Ligia Castellon Figueiredo; VISCONDI, Juliana Yukari Kodaira; NOVAES, Hillegonda Maria DutilhBackground: Pertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil. Methods: Economic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed. Results: Maternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness. Conclusion: The results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
- Influence of Prior Knowledge of Human Papillomavirus Status on the Performance of Cytology Screening(2018) MARTINS, Toni Ricardo; LONGATTO-FILHO, Adhemar; COHEN, Diane; VISCONDI, Juliana Yukari Kodaira; FUZA, Luiz Mario; CURY, Lise; VILLA, Luisa Lina; LEVI, Jose Eduardo; ELUF-NETO, JoseObjectives: This study aimed to evaluate the influence of prior knowledge of human papillomavirus (HPV) status in cervical cytopathology readings. Methods: Participants comprised 2,376 women who underwent parallel cytology and HPV-DNA testing. Smears were read twice by the same team, first with previous knowledge of HPV-DNA status. Results: Overall, 239 (10.2%) smears had their cytology classification altered by the HPV-informed review. Cytology readings with prior knowledge of the HPV status revealed 10.5% of abnormal smears (atypical squamous cells of undetermined significance or higher), while without prior knowledge, this rate dropped to 7.6%. When HPV status was informed, a significant increase in all categories of altered smears was observed. Cytology with prior knowledge of HPV status detected more cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) compared with blinded: 86.7% vs 60.0%. Conclusions: Our data indicate that cytology interpreted with prior knowledge of the HPV status provides higher sensitivity for CIN 2+ lesions while marginally reducing the overall specificity compared with HPV status blinded cytology.
- Risk factors associated with the development of gastric cancer - case-control study(2018) RAMOS, Marcus Fernando Kodama Pertille; RIBEIRO JUNIOR, Ulysses; VISCONDI, Juliana Kodaira Yukari; ZILBERSTEIN, Bruno; CECCONELLO, Ivan; ELUF-NETO, Jose
- All-Cause Mortality Attributable to Sitting Time Analysis of 54 Countries Worldwide(2016) REZENDE, Leandro Fornias Machado de; SA, Thiago Herick de; MIELKE, Gregore Iven; VISCONDI, Juliana Yukari Kodaira; REY-LOPEZ, Juan Pablo; GARCIA, Leandro Martin TotaroIntroduction: Recent studies have shown that sitting time is associated with increased risk of all-cause mortality, independent of moderate to vigorous physical activity. Less is known about the population-attributable fraction for all-cause mortality associated with sitting time, and the gains in life expectancy related to the elimination of this risk factor. Methods: In November 2015, data were gathered from one published meta-analysis, 54 adult surveys on sitting time distribution (from 2002 to 2011), in conjunction with national statistics on population size, life table, and overall deaths. Population-attributable fraction for all-cause mortality associated with sitting time > 3 hours/day was estimated for each country, WHO regions, and worldwide. Gains in life expectancy related to the elimination of sitting time > 3 hours/day was estimated using life table analysis. Results: Sitting time was responsible for 3.8% of all-cause mortality (about 433,000 deaths/year) among those 54 countries. All-cause mortality due to sitting time was higher in the countries from the Western Pacific region, followed by European, Eastern Mediterranean, American, and Southeast Asian countries. Eliminating sitting time would increase life expectancy by 0.20 years in those countries. Conclusions: Assuming that the effect of sitting time on all-cause mortality risk is independent of physical activity, reducing sitting time plays an important role in active lifestyle promotion, which is an important aspect of premature mortality prevention worldwide.