Trentini Bruno, Steindel Mário, Marlow Mariel A
School of Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
PLoS One. 2014 Sep 8;9(9):e106635. doi: 10.1371/journal.pone.0106635. eCollection 2014.
Brazil has implemented systematic control methods for leishmaniasis for the past 30 years, despite an increase in cases and continued spread of the disease to new regions. A lack high quality evidence from epidemiological observational studies impedes the development of novel control methods to prevent disease transmission among the population. Here, we have evaluated the quality of observational studies on leishmaniasis conducted in Brazil to highlight this issue.
METHODS/PRINCIPAL FINDINGS: For this systematic review, all publications on leishmaniasis conducted in Brazil from January 1st, 2002 to December 31st, 2012 were screened via Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to select observational studies involving human subjects. The 283 included studies, representing only 14.1% of articles screened, were then further evaluated for quality of epidemiological methods and study design based on the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) checklists. Over half of these studies were descriptive or case reports (53.4%, 151), followed by cross-sectional (20.8%, n = 59), case-control (8.5%, n = 24), and cohort (6.0%, n = 17). Study design was not stated in 46.6% (n = 181) and incorrectly stated in 17.5% (n = 24). Comparison groups were utilized in just 39.6% (n = 112) of the publications, and only 13.4% (n = 38) employed healthy controls. Majority of studies were performed at the city-level (62.9%, n = 178), in contrast with two (0.7%) studies performed at the national-level. Coauthorship networks showed the number of author collaborations rapidly decreased after three collaborations, with 70.9% (n = 659/929) of coauthors publishing only one article during the study period.
CONCLUSIONS/SIGNIFICANCE: A review of epidemiological research in Brazil revealed a major lack of quality and evidence. While certain indicators suggested research methods may have improved in the last two years, an emphasis on observational research which employs comparison groups and representative samples is urgently needed.
在过去30年里，巴西一直在实施利什曼病的系统控制方法，尽管病例有所增加，且该疾病持续向新的地区传播。缺乏来自流行病学观察性研究的高质量证据阻碍了开发新的控制方法以预防疾病在人群中传播。在此，我们评估了巴西开展的利什曼病观察性研究的质量，以凸显这一问题。
方法/主要发现：对于这项系统评价，通过系统评价和Meta分析的首选报告项目（PRISMA）清单筛选了2002年1月1日至2012年12月31日在巴西开展的所有关于利什曼病的出版物，以选择涉及人类受试者的观察性研究。纳入的283项研究仅占筛选文章的14.1%，然后根据加强流行病学观察性研究报告（STROBE）清单对这些研究的流行病学方法和研究设计质量进行进一步评估。这些研究中超过一半是描述性研究或病例报告（53.4%，151项），其次是横断面研究（20.8%，n = 59）、病例对照研究（8.5%，n = 24）和队列研究（6.0%，n = 17）。46.6%（n = 181）的研究未说明研究设计，17.5%（n = 24）的研究说明错误。仅39.6%（n = 112）的出版物使用了对照组，只有13.4%（n = 38）使用了健康对照。大多数研究在城市层面开展（62.9%，n = 178），相比之下，在国家层面开展的研究有两项（0.7%）。合著网络显示，三次合作后作者合作的数量迅速减少，70.9%（n = 659/929）的合著者在研究期间仅发表了一篇文章。
结论/意义：对巴西流行病学研究的回顾揭示了质量和证据的严重缺乏。虽然某些指标表明研究方法在过去两年可能有所改进，但迫切需要强调采用对照组和代表性样本的观察性研究。
