Emil Kupek | Universidade Federal de Santa Catarina - UFSC (original) (raw)

Papers by Emil Kupek

Longitudinal study, whose objective was to present a better strategy and statistical methods, and... more Longitudinal study, whose objective was to present a better strategy and statistical methods, and demonstrate its use with the data across the 2013-2015 period in schoolchildren aged 7 to 11 years, covered with the same food questionnaire (WebCAAFE) survey in Florianopolis, southern Brazil. Six meals/snacks and 32 foods/beverages yielded 192 possible combinations denominated meal/snack-Specific Food/ beverage item (MSFIs). LASSO algorithm (LAS-SO-logistic regression) was used to determine the MSFIs predictive of overweight/obesity, and then binary (logistic) regression was used to further analyze a subset of these variables. Late breakfast, lunch and dinner were all associated with increased overweight/obesity risk, as was an anticipated lunch. Time-of-day or meal-tagged food/ beverage intake result in large number of variables whose predictive patterns regarding weight status can be analyzed by machine learning such as LASSO, which in turn may identify the patterns not amenable to other popular statistical methods such as binary logistic regression.

Thrombosis Journal, Jul 28, 2023

Background Because severe acute respiratory syndrome coronarivus 2 (SARS-CoV-2) leads to severe c... more Background Because severe acute respiratory syndrome coronarivus 2 (SARS-CoV-2) leads to severe conditions and thrombus formation, evaluation of the coagulation markers is important in determining the prognosis and phenotyping of patients with COVID-19. Methods In a prospective study that included 213 COVID-19 patients admitted to the intensive care unit (ICU) the levels of antithrombin, C-reactive protein (CRP); factors XI, XII, XIII; prothrombin and D-dimer were measured. Spearman's correlation coefficient was used to assess the pairwise correlations between the biomarkers. Hierarchical and non-hierarchical cluster analysis was performed using the levels of biomarkers to identify patients´ phenotypes. Multivariate binary regression was used to determine the association of the patient´s outcome with clinical variables and biomarker levels. Results The levels of factors XI and XIII were significantly higher in patients with less severe COVID-19, while factor XIII and antithrombin levels were significantly associated with mortality. These coagulation biomarkers were associated with the in-hospital survival of COVID-19 patients over and above the core clinical factors on admission. Hierarchical cluster analysis showed a cluster between factor XIII and antithrombin, and this hierarchical cluster was extended to CRP in the next step. Furthermore, a non-hierarchical K-means cluster analysis was performed, and two phenotypes were identified based on the CRP and antithrombin levels independently of clinical variables and were associated with mortality. Conclusion Coagulation biomarkers were associated with in-hospital survival of COVID-19 patients. Lower levels of factors XI, XII and XIII and prothrombin were associated with disease severity, while higher levels of both CRP and antithrombin clustered with worse prognosis. These results suggest the role of coagulation abnormalities in the development of COVID-19 and open the perspective of identifying subgroups of patients who would benefit more from interventions focused on regulating coagulation.

Arquivos De Neuro-psiquiatria, May 1, 2023

Background Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically releva... more Background Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the GCS-Pupil score (GCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining GCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of GCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the GCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n ¼ 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the

Medical research archives, 2023

Background-Little is known about the time trend in mortality rates due to respiratory viruses oth... more Background-Little is known about the time trend in mortality rates due to respiratory viruses other than SARS-CoV-2 and seasonal influenza among Brazilian children and adolescents. Methods-Study outcomes were mortality rates due to influenza A, influenza B, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, for age groups <5, 5-9, and 10-19 years of age, in Brazil, over the 2009-2022 period. Secondary data from the Brazilian Ministry of Health were analyzed by interval regression, bounded between reported deaths and estimated upper limit of this number, which took into account the underestimation of deaths, the error in attributing its causes in official records, and the variation due to Poisson distribution. Results-For all viruses, mortality varied little among the children under five years of age, and increased gradually among the 5-10 and 11-19-years old. The highest average mortality rates per million inhabitants over the 2009-2022 period were estimated for respiratory syncytial virus (1.04), with the lowest values for parainfluenza (0.54) and influenza B (0.55), and intermediate values in the range of 0.90 to 0.95 for influenza A, bocavirus, metapneumovirus, rhinovirus, adenovirus, and other respiratory viruses except SARS-Cov-2. Age groups of 5-9 and 10-19 years of age had similar mortality rates and were by far the largest contributors to the overall mortality rates for all viruses analyzed. Conclusion-Schoolchildren mortality due to respiratory viruses in Brazil has been rising for at least five years before the COVID-19 pandemic, and remained elevated during the pandemic. In addition to SARS-CoV-2 and seasonal influenza, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, all showed a non-ignorable impact on mortality in this age group.

Frontiers in Neurology, Apr 25, 2019

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to prema... more Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did Areas et al. Burden of TBI in Brazil not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower-and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.

Social Science & Medicine, May 1, 1999

We examined the influence of demographic, social and economic background of people with HIV/AIDS ... more We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions.

Anais dos Seminários de Iniciação Científica, 2021

No mundo todo aproximadamente 4/5 dos jovens não atingem as recomendações diárias de atividade fí... more No mundo todo aproximadamente 4/5 dos jovens não atingem as recomendações diárias de atividade física (AF) moderada a vigorosa (Poitras et al., 2016). Em paralelo, vem crescendo o tempo em comportamentos sedentários (CS), gerando influência negativa a saúde (Carson et al., 2016).

Revista Brasileira De Reumatologia, Apr 1, 2005

American Journal of Physical Medicine & Rehabilitation, May 10, 2023

Fonte de financiamento: Kleber dos Santos was awarded a scholarship from the CAPES agency of the ... more Fonte de financiamento: Kleber dos Santos was awarded a scholarship from the CAPES agency of the Brazilian Ministry of Education during his M.Sc. course. This research received institutional support from state administration (SEA/SC) to use the relevant data from the hospital workers' employment records, as well as to aid the questionnaire data collection by soliciting the cooperation of the hospital personnel departments. Conflito de interesse: nada a declarar.

Cadernos De Saude Publica, Oct 1, 2013

The main objectives of this study were to estimate the prevalence of blood donation and to identi... more The main objectives of this study were to estimate the prevalence of blood donation and to identify associated factors. A populated-based cross-sectional study was carried out (n = 1,720) including subjects 20 to 59 years of age in Florianópolis, Santa Catarina State, Brazil. Blood donation any time in life and in the previous year was reported by 30.6% and 6.2% of respondents, respectively. Among the latter, 31.8% reported repeat donation (at least twice in the previous year), 80.4% reported voluntary donation, and 15.9% replacement donation. Multivariate Poisson regression (p < 0.05) showed that male gender, black or brown self-reported skin color, higher age group, higher educational level, and living with other blood donors were all associated with ever donating blood, whereas younger age, single marital status, and higher educational level were associated with donating in the previous year. We found higher prevalence of blood donation in the previous year and higher percentage of young donors in this group, as well as lower percentage of replacement donors than previously reported in Brazil.

Revista Brasileira De Epidemiologia, 2021

To investigate the relation between COVID-19 vaccine coverage and COVID-19-related mortality by a... more To investigate the relation between COVID-19 vaccine coverage and COVID-19-related mortality by age groups in Brazil in 2021. Methods: Secondary data on COVID-19 deaths and vaccination coverage were retrieved to investigate COVID-19 mortality rate (MR) evolution as the vaccination against COVID-19 advanced in Brazil in 2021. Poisson regression with adjustment for age and Brazilian states was used to calculate the MR. Results: By mid-April 2021, MR increased 2-3 times compared with the already high level in January for people aged 60 years or older, reaching the highest epidemic level of 5-15 per 100,000 inhabitants in this age group. Despite the following decline trend, by the end of May, the MR level was still about 50% and 80% higher for the age groups of 40-79 years and 80 years or older. The coverage concerning the first dose of COVID-19 vaccine reached 80% for people aged 60-69 years and exceeded 95% for those aged 70 years or older, but the second dose was only given to 26, 76 and 64% of the age groups of 60-69, 70-79, and 80 years or older, respectively. The age-standardized average MR over the study period was the highest in northern Brazilian states of Rondônia, Amazonas, Acre, and Roraima (range 6-8.4 per 100,000 inhabitants). Conclusions: COVID-19 vaccination coverage was below the level necessary to protect Brazilians from rising MR between January and May 2021. Urgent measures are necessary to increase the vaccine supply and the adherence to non-pharmacological protective measures.

JMED research, Jul 7, 2014

There is a paucity of publications on regional variations in seroprevalence of infectious disease... more There is a paucity of publications on regional variations in seroprevalence of infectious diseases in blood donors within Brazilian states, so that suitable time trends can be derived for major demographic groups. A population study of blood donors in the southern state of Santa Catarina, Brazil, was conducted using all computerized records of the blood donors submitted to serologic screening in 2010. The subjects were predominantly male (57.8%), aged 18-25 years (33.5%), did not direct their donation to any specific recipient (55.6%), nor did they provide another blood donation in last 12 months (58.6%). The highest seroprevalence was observed for the hepatitis B markers (3.0% for anti-HBc and 0.2% for HBsAg), followed by those for syphilis (0, 08% VDRL), HIV-1 (0.06%), hepatitis C (0.05%), HTLV1/2 (0.01%) and Chagas disease (0.01%). The risk factors associated with higher seroprevalence were associated with the first time donation, being male and of older age. Large regional variations were observed, with the Far West region reaching 7% of anti-HBc and 0.5% of HBsAg positive, and the Midwest region showing 0.1% HIV-positive donors. Hepatits B markers of both lifetime and recent infection reached a high level among blood donor candidates in Santa Catarina in 2010 and remain the foremost serological deferral criterion, despite some evidence of the reduced transmission rate compared to the beginning of the decade. The seroprevalence of other sexually transmitted infections (HIV, syphilis) also persisted on a level too high for a blood donor population, implying even higher prevalence in the general population.

Revista Brasileira de Saúde Ocupacional, 2021

Objetivo: analisar a tendência temporal da mortalidade por acidentes de trabalho (AT) no Brasil d... more Objetivo: analisar a tendência temporal da mortalidade por acidentes de trabalho (AT) no Brasil de 2006 a 2015 e investigar desigualdades segundo sexo, raça/cor da pele, faixa etária, escolaridade e macrorregiões. Métodos: estudo ecológico de tendência temporal, com dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Utilizaram-se regressões de Poisson. Resultados: as taxas anuais médias (TAM) de mortalidade por acidente de trabalho mantiveram-se relativamente estáveis no período (variação anual de até 5%), mas alguns grupos e regiões apresentaram tendência de aumento. Mulheres acima de 60 anos da região Centro-Oeste (TAM: 1,21-IC95%: 1,03-1,42) e os trabalhadores pardos de todas as regiões (TAM: 1,03 IC95%: 1,02-1,04) apresentaram aumento significativo na mortalidade. Em 2015, a mortalidade por AT na região Nordeste foi 88% maior entre os pardos (2,45/100 mil) do que entre os brancos (1,30/100 mil), e no Brasil, a mortalidade de trabalhadores com menos de oito anos de estudo foi 15 vezes superior à daqueles com 12 anos de estudo ou mais (4,74/100 mil vs. 0,31/100 mil). Conclusões: embora estável, a taxa de mortalidade por AT no Brasil é elevada, se comparada à dos países de alta renda. Alguns grupos populacionais (homens, pretos, pardos, índios, pessoas com baixa escolaridade) e regiões do país (Norte, Nordeste e Centro-Oeste) apresentam taxas ainda mais elevadas. Palavras-chave: acidentes de trabalho; mortalidade ocupacional; saúde do trabalhador; desigualdades em saúde; estudos de séries temporais.

Cadernos De Saude Publica, 2020

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribut... more Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.

Revista Brasileira de Educação Médica, 2022

Introdução: Não se sabe se a ausência de estudantes de Medicina ao Teste de Progresso (TP) se dá ... more Introdução: Não se sabe se a ausência de estudantes de Medicina ao Teste de Progresso (TP) se dá de forma aleatória ou por alguma característica sistemática deles, o que poderia influenciar a representatividade dos resultados obtidos pelos participantes. Objetivo: Este estudo teve como objetivos comparar os índices de desempenho acadêmico, no curso de Medicina da UFSC, dos alunos presentes e ausentes ao TP em 2019; propor uma maneira de estimar, a partir desses índices, quais seriam as notas dos faltantes se tivessem participado do TP; e identificar fatores associados à ausência ao TP. Método: Foram comparadas as médias dos índices de desempenho acadêmico, globais e nas diferentes fases (semestres) dos grupos de alunos presentes e ausentes ao TP, utilizando teste t de Student para amostras independentes. Por meio de uma técnica de regressão linear, foram imputadas as prováveis notas no TP ao grupo de alunos ausentes. Resultado: As médias globais dos três indicadores acadêmicos foram significativamente menores nos alunos ausentes ao TP (p variando de < 0,03 a < 0,0001); em dez das 11 fases (semestres) analisadas do curso, os indicadores acadêmicos dos faltosos foram piores do que dos presentes. A imputação de notas no TP aos ausentes permitiu verificar que existe correlação (R = 0,62) entre a porcentagem destes e a diferença de notas entre os grupos que realizaram e os que faltaram ao TP. Entre os alunos do gênero masculino, 25,8% não fizeram o TP, enquanto no gênero feminino foram 16,6% (diferença com p < 0,01). Conclusão: A ausência de alunos ao TP não se dá de forma aleatória. Entre os faltosos, há uma tendência sistemática de existirem alunos com piores índices de desempenho acadêmico. O uso de imputação múltipla de dados evidencia uma correlação entre a porcentagem de faltosos e a diferença na média da nota no TP, desse grupo, comparada à média da nota dos participantes. A proporção de homens que faltaram ao TP foi significativamente maior do que a de mulheres.

Todo o conteúdo deste livro está licenciado sob uma Licença de Atribuição Creative Commons. Atrib... more Todo o conteúdo deste livro está licenciado sob uma Licença de Atribuição Creative Commons. Atribuição 4.0 Internacional (CC BY 4.0). O conteúdo dos artigos e seus dados em sua forma, correção e confiabilidade são de responsabilidade exclusiva dos autores. Permitido o download da obra e o compartilhamento desde que sejam atribuídos créditos aos autores, mas sem a possibilidade de alterá-la de nenhuma forma ou utilizá-la para fins comerciais.

Pathogens, Nov 14, 2019

Background: Previous studies found a high prevalence of pathogens among female sex workers (FSWs)... more Background: Previous studies found a high prevalence of pathogens among female sex workers (FSWs) in the Amazon region, and established their parenteral and sexual transmission. This study estimated the prevalence of hepatitis C virus (HCV) infection and associated risk factors, and the frequency of HCV genotypes and resistance-associated substitutions (RASs) in this vulnerable group. Methods: Distinct sampling methods were used to access 412 FSWs in cities and riverside communities in the Amazon region from 2015 to 2018. Three methods for HCV diagnosis were used to determine infection status. HCV genotypes and RASs were identified by sequencing and nucleotide fragment analysis. An association between HCV infection and exposure factors was determined by bivariate and multivariate analysis. Results: In total, 44 (10.7%) FSWs were exposed to HCV, and 32 (7.8%) of them had active infection. Nine socioeconomic characteristics and risky sexual behaviors were associated with HCV exposure, particularly unprotected sex and condom exemption for the clients who paid extra money. Genotype 1 (81.3%) and 3 (18.7%) were detected. The frequency of FSWs with RASs was 23.1% (6/26) for grazoprevir related to the occurrence of substitutions Y56F and S122G. Conclusions: HCV infection among FSWs is highly prevalent and dominated by genotype I. Urgent preventive and treatment measures are required to reduce HCV infection in FSWs and the general population.