Work ability and associated factors in people living with human T-cell leukemia virus type 1

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ABSTRACT

Background:

Infection with the human T-lymphotropic virus type 1 (HTLV-1) affects an estimated 10-15 million people worldwide. However, knowledge of the impact of HTLV-1 infection on work ability is lacking. This study aimed to measure the frequency and identify factors associated with poor work ability in patients living with HTLV-1.

Methods:

This cross-sectional study included 207 individuals infected with HTLV-1 who attended the University Hospital in Salvador, Bahia, Brazil. HTLV-1 antibodies were detected in the participants’ blood by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blotting. Participants answered a questionnaire on sociodemographic data, personal habits, clinical data, health-related quality of life, and work ability, evaluated using the work ability index questionnaire. A Poisson regression model with a robust variance estimate was used to identify the factors associated with the prevalence of poor work ability.

Results:

Patients mean age was 55.2, ranging from 19 to 84 years, 73.0% were females, 100% had monthly family income less than US$ 394, and 33.8% presented HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). No individual was classified as having excellent work ability. Poor work ability prevalence was strongly associated (prevalence ratio; 95% confidence interval [CI]) with sedentarism (1.30; 1.03-1.65), neurological symptoms (1.25; 1.02-1.52), and low physical (0.95; 0.94-0.96) and mental (0.98; 0.97-0.99) component summaries of health-related quality of life.

Conclusions:

Poor work ability among people living with HTLV-1 is associated with sedentarism, neurologic symptoms, and low health-related quality of life.

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Most cited references 39

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The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education

Keith Taber (2018)

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Measurement of health status. Ascertaining the minimal clinically important difference.

R Jaeschke, J Singer, G H Guyatt (1989)

In recent years quality of life instruments have been featured as primary outcomes in many randomized trials. One of the challenges facing the investigator using such measures is determining the significance of any differences observed, and communicating that significance to clinicians who will be applying the trial results. We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change. Using this approach we have established a plausible range within which the minimal clinically important difference (MCID) falls. In three studies in which instruments measuring dyspnea, fatigue, and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item, when responses were presented on a seven point Likert scale. Furthermore, we have established ranges for changes in questionnaire scores that correspond to moderate and large changes in the domains of interest. This information will be useful in interpreting questionnaire scores, both in individuals and in groups of patients participating in controlled trials, and in the planning of new trials.

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Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio

Aluisio Barros, Vânia Hirakata (2003)

Background Cross-sectional studies with binary outcomes analyzed by logistic regression are frequent in the epidemiological literature. However, the odds ratio can importantly overestimate the prevalence ratio, the measure of choice in these studies. Also, controlling for confounding is not equivalent for the two measures. In this paper we explore alternatives for modeling data of such studies with techniques that directly estimate the prevalence ratio. Methods We compared Cox regression with constant time at risk, Poisson regression and log-binomial regression against the standard Mantel-Haenszel estimators. Models with robust variance estimators in Cox and Poisson regressions and variance corrected by the scale parameter in Poisson regression were also evaluated. Results Three outcomes, from a cross-sectional study carried out in Pelotas, Brazil, with different levels of prevalence were explored: weight-for-age deficit (4%), asthma (31%) and mother in a paid job (52%). Unadjusted Cox/Poisson regression and Poisson regression with scale parameter adjusted by deviance performed worst in terms of interval estimates. Poisson regression with scale parameter adjusted by χ2 showed variable performance depending on the outcome prevalence. Cox/Poisson regression with robust variance, and log-binomial regression performed equally well when the model was correctly specified. Conclusions Cox or Poisson regression with robust variance and log-binomial regression provide correct estimates and are a better alternative for the analysis of cross-sectional studies with binary outcomes than logistic regression, since the prevalence ratio is more interpretable and easier to communicate to non-specialists than the odds ratio. However, precautions are needed to avoid estimation problems in specific situations.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Soc Bras Med Trop

Journal ID (iso-abbrev): Rev Soc Bras Med Trop

Journal ID (publisher-id): rsbmt

Title: Revista da Sociedade Brasileira de Medicina Tropical

Publisher: Sociedade Brasileira de Medicina Tropical - SBMT

ISSN (Print): 0037-8682

ISSN (Electronic): 1678-9849

Publication date (Electronic, pub): 05 August 2022

Publication date (Electronic, collection): 2022

Volume: 55

Electronic Location Identifier: e0111-2022

Affiliations

[1 ] Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil.

[2 ] Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brasil.

[3 ] Universidade Federal da Bahia, Faculdade de Odontologia, Salvador, BA, Brasil.

Author notes

Corresponding author: Liliane Lins-Kusterer. e-mail: lkusterer@ 123456gmail.com

Authors’ contribution: FMC, CB, LL-K: Conception and design; DA, NMV, GGSCF, VAS: Acquisition of data; FMC, CB, LL-K: Analysis and interpretation of data; DA, NMV, FMC, LL-K: Participation in the article draft; GGSCF, VAS, CB: Critical review of the article for important intellectual content. All authors approved the final version of the manuscript.

Conflict of interest: The authors declare no conflict of interest.