From b17fdbc8bf739bf1ae86ee0c2ff4ebbb661c0363 Mon Sep 17 00:00:00 2001
From: Felipe Figueiredo <felipe.figueiredo@bio.fiocruz.br>
Date: Tue, 12 Jun 2018 17:44:32 -0300
Subject: [PATCH] =?UTF-8?q?visualiza=C3=A7=C3=B5es=20atualizadas?=
MIME-Version: 1.0
Content-Type: text/plain; charset=UTF-8
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---
 figures/painel_Alfa_Tor_dor.png  | Bin 7857 -> 4044 bytes
 figures/painel_Alfa_Tor_dor2.png | Bin 10026 -> 4963 bytes
 figures/painel_Alfa_Tor_sex.png  | Bin 7301 -> 3929 bytes
 figures/painel_Alfa_Tor_sex2.png | Bin 9045 -> 4725 bytes
 report/analise_dados_FP_2017.md  | 296 ++++++++++++++++---------------
 5 files changed, 150 insertions(+), 146 deletions(-)

diff --git a/figures/painel_Alfa_Tor_dor.png b/figures/painel_Alfa_Tor_dor.png
index 1e8fdd8dc597cb7c12291a8db149b9e2e5150c8e..b37a51ee172f6133baff20da29bf07da402e25c6 100644
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diff --git a/report/analise_dados_FP_2017.md b/report/analise_dados_FP_2017.md
index bb58305..ee9d37e 100644
--- a/report/analise_dados_FP_2017.md
+++ b/report/analise_dados_FP_2017.md
@@ -46,7 +46,50 @@ toc-title: "Sumário"
 
 # Metodologia
 
-Esta análise foi realizada utilizando-se o software `R` versão 3.4.3.
+## Diagnóstico sistemático
+
+As medidas obtidas por avaliação clínica e radiológica foram utilizadas para classificar sistematicamente o tipo de impacto.
+Foram considerados impactos CAM aqueles participantes que tinham ângulo alfa maior que 50 graus.
+Para classificar o impacto do tipo PINCER foi considerada qualquer uma das seguintes medidas:
+
+- índice acetabuar maior que 10 graus;
+- ângulo centro-borda acetabular maior que 39 graus;
+- índice de extrusão menor que 10 graus.
+
+Participantes que possuíam tanto impacto CAM quanto PINCER no mesmo lado do quadril foram posteriormente classificados como impacto MISTO.
+Observe que isto não considera um paciente com CAM em um lado e PINCER no outro como um paciente de impacto MISTO.
+
+### Exceções
+
+**CAM**
+
+Um participante não teve seu ângulo alfa mensurado no lado direito, ele foi diagnosticado clinicamente como não possuindo impacto CAM.
+
+**PINCER**
+
+Um segundo participante não teve seu ângulo centro-borda cetabular mensurado no lado direito, e seu diagnóstico clínico foi de que não possuía PINCER.
+Um terceiro participante não teve seus índices de extrusão mensurados em ambos os lados.
+Seu diagnóstico clínico foi de que possuía PINCER apenas no quadril esquerdo.
+
+## Análises estatísticas
+
+As variáveis categóricas foram avaliadas quanto às suas frequências, sendo apresentadas em porcentagem.
+Associações entre duas variáveis categóricas foram avaliadas usando-se o teste exato de Fisher.
+As variáveis contínuas foram descritas com médias e desvio padrão.
+As diferenças médias entre dois grupos de medidas foram avaliadas com o teste t de Student.
+
+Além dos testes de significância, diversos modelos estatísticos foram criados para avaliar hipóteses sobre a relação entre os desfechos de interesse e os ângulos mensurados, como torção.
+
+<!-- Para as hipóteses em que o desfecho era uma variável categórica binária, foi utilizado o modelo de regressão logística. -->
+Quando o desfecho era uma variável categória com 3 ou mais categorias, como por exemplo o lado doloroso (direito, esquerdo ou bilateral) usou-se o modelo de regressão multinomial.
+
+Esta estratégia de modelagem permite estimar a Razão de Chance de uma determinada combinação de fatores e medidas afetar a probabilidade de trocar de uma categoria para outra.
+Por exemplo, o tipo de impacto que o participante apresenta pode aumentar a chance do participante sentir dor naquele lado, mas isso pode ocorrer de forma diferenciada para cada gênero, ou ser influenciada pelo ângulo de torção, IMC, etc.
+Assim é possível controlar o efeito observado por outros fatores que possam estar relacionados.
+
+Para avaliar a influência de diversos fatores na medida do ângulo de torção, foram usados modelos de regressão linear múltipla, o que permite controlar a observação do efeito por fatores adicionais que possivelmente influenciam no valor deste ângulo.
+
+Todas as análises foram realizadas utilizando-se o software `R` versão 3.4.3.
 
 <!-- The exact confidence intervals (CIs) of binomial proportions were calculated using package `exactci` (version 1.3.3). -->
 
@@ -54,98 +97,62 @@ Esta análise foi realizada utilizando-se o software `R` versão 3.4.3.
 
 
 
-## Descritivas
-
-### Tabela básica
-
-
-|           &nbsp;           |  level  |    Overall    |
-|:--------------------------:|:-------:|:-------------:|
-|           **n**            |         |      26       |
-|        **SEXO (%)**        |    F    |   7 (26.9)    |
-|                            |    M    |   19 (73.1)   |
-|   **IDADE (mean (sd))**    |         | 35.00 (6.70)  |
-|        **RACA (%)**        | Outros  |   7 (26.9)    |
-|                            | Branca  |   19 (73.1)   |
-|    **IMC (mean (sd))**     |         | 24.02 (4.15)  |
-|      **LADO DOR (%)**      |    D    |   13 (50.0)   |
-|                            |    E    |   4 (15.4)    |
-|                            |    B    |   9 (34.6)    |
-|    **HHS (mean (sd))**     |         | 67.12 (13.25) |
-|  **TORCAO D (mean (sd))**  |         | 14.15 (10.30) |
-|  **TORCAO E (mean (sd))**  |         | 15.00 (7.81)  |
-|      **TONNIS D (%)**      |    0    |   9 (34.6)    |
-|                            |    1    |   14 (53.8)   |
-|                            |    2    |   3 (11.5)    |
-|      **TONNIS E (%)**      |    0    |   11 (42.3)   |
-|                            |    1    |   11 (42.3)   |
-|                            |    2    |   4 (15.4)    |
-|   **ACB D (mean (sd))**    |         | 34.68 (8.93)  |
-|   **ACB E (mean (sd))**    |         | 32.00 (7.48)  |
-|    **IA D (mean (sd))**    |         |  1.42 (4.94)  |
-|    **IA E (mean (sd))**    |         |  0.73 (5.33)  |
-|   **ACD D (mean (sd))**    |         | 135.77 (5.55) |
-|   **ACD E (mean (sd))**    |         | 134.19 (5.06) |
-|   **ALFA D (mean (sd))**   |         | 63.84 (14.03) |
-|   **ALFA E (mean (sd))**   |         | 55.42 (12.04) |
-| **I. EXTRU D (mean (sd))** |         | 14.52 (10.76) |
-| **I. EXTRU E (mean (sd))** |         | 14.92 (13.00) |
-|        **CAM (%)**         |    N    |   4 (15.4)    |
-|                            |    D    |   6 (23.1)    |
-|                            |    E    |   2 ( 7.7)    |
-|                            |    B    |   14 (53.8)   |
-|       **PINCER (%)**       |    N    |   9 (34.6)    |
-|                            |    D    |   4 (15.4)    |
-|                            |    E    |   3 (11.5)    |
-|                            |    B    |   10 (38.5)   |
-|       **MISTO (%)**        | Simples |   15 (57.7)   |
-|                            |    D    |   4 (15.4)    |
-|                            |    E    |   2 ( 7.7)    |
-|                            |    B    |   5 (19.2)    |
-
-Table: Tabela descritiva básica (univariada) - EXCLUIR linhas relativas a colunas da tabela que  não foram usadas!
-
-### Tabelas estratificadas
-
-
-|         &nbsp;         | level  |       D       |       E       |   p    |
-|:----------------------:|:------:|:-------------:|:-------------:|:------:|
-|         **n**          |        |      26       |      26       |        |
-|      **LADO (%)**      |   D    |  26 (100.0)   |   0 (  0.0)   | <0.001 |
-|                        |   E    |   0 (  0.0)   |  26 (100.0)   |        |
-|      **SEXO (%)**      |   F    |   7 ( 26.9)   |   7 ( 26.9)   | 1.000  |
-|                        |   M    |  19 ( 73.1)   |  19 ( 73.1)   |        |
-|      **RACA (%)**      | Outros |   7 ( 26.9)   |   7 ( 26.9)   | 1.000  |
-|                        | Branca |  19 ( 73.1)   |  19 ( 73.1)   |        |
-|      **DOR (%)**       |   D    |  13 ( 50.0)   |  13 ( 50.0)   | 1.000  |
-|                        |   E    |   4 ( 15.4)   |   4 ( 15.4)   |        |
-|                        |   B    |   9 ( 34.6)   |   9 ( 34.6)   |        |
-| **TORCAO (mean (sd))** |        | 14.15 (10.30) | 15.00 (7.81)  | 0.740  |
-|  **ALFA (mean (sd))**  |        | 63.84 (14.03) | 55.42 (12.04) | 0.026  |
-|      **CAM (%)**       |   N    |   4 ( 15.4)   |   4 ( 15.4)   | 1.000  |
-|                        |   D    |   6 ( 23.1)   |   6 ( 23.1)   |        |
-|                        |   E    |   2 (  7.7)   |   2 (  7.7)   |        |
-|                        |   B    |  14 ( 53.8)   |  14 ( 53.8)   |        |
-|     **PINCER (%)**     |   N    |   9 ( 34.6)   |   9 ( 34.6)   | 1.000  |
-|                        |   D    |   4 ( 15.4)   |   4 ( 15.4)   |        |
-|                        |   E    |   3 ( 11.5)   |   3 ( 11.5)   |        |
-|                        |   B    |  10 ( 38.5)   |  10 ( 38.5)   |        |
-|    **IMPACTO (%)**     | NORMAL |  11 ( 42.3)   |   9 ( 34.6)   | 0.532  |
-|                        |  CAM   |   9 ( 34.6)   |   7 ( 26.9)   |        |
-|                        | PINCER |   1 (  3.8)   |   4 ( 15.4)   |        |
-|                        | MISTO  |   5 ( 19.2)   |   6 ( 23.1)   |        |
-
-Table: Tabela por lado da medição
+## Descrição dos participantes do estudo
+
+A Tabela 1 apresenta as características gerais dos participantes do estudo.
+
+
+|        &nbsp;         | level  |    Overall    |
+|:---------------------:|:------:|:-------------:|
+|         **n**         |        |      26       |
+|     **SEXO (%)**      |   F    |   7 (26.9)    |
+|                       |   M    |   19 (73.1)   |
+| **IDADE (mean (sd))** |        | 35.00 (6.70)  |
+|     **RACA (%)**      | Outros |   7 (26.9)    |
+|                       | Branca |   19 (73.1)   |
+|  **IMC (mean (sd))**  |        | 24.02 (4.15)  |
+|   **LADO DOR (%)**    |   D    |   13 (50.0)   |
+|                       |   E    |   4 (15.4)    |
+|                       |   B    |   9 (34.6)    |
+|  **HHS (mean (sd))**  |        | 67.12 (13.25) |
+
+Table: **Tabela 1** Descrição dos participantes do estudo (N = 26).
+sd = Desvio padrão,
+IMC = Índice de massa corpórea,
+HHS = Harris hip score (modificado).
+
+
+|         &nbsp;         | level  |       D       |       E       |   p   |
+|:----------------------:|:------:|:-------------:|:-------------:|:-----:|
+| **TORCAO (mean (sd))** |        | 14.15 (10.30) | 15.00 (7.81)  | 0.740 |
+|  **ALFA (mean (sd))**  |        | 63.84 (14.03) | 55.42 (12.04) | 0.026 |
+|   **IA (mean (sd))**   |        |  1.42 (4.94)  |  0.73 (5.33)  | 0.629 |
+|  **ACB (mean (sd))**   |        | 34.68 (8.93)  | 32.00 (7.48)  | 0.250 |
+| **EXTRU (mean (sd))**  |        | 14.52 (10.76) | 14.92 (13.00) | 0.906 |
+|    **IMPACTO (%)**     | NORMAL |  11 ( 42.3)   |   9 ( 34.6)   | 0.532 |
+|                        |  CAM   |   9 ( 34.6)   |   7 ( 26.9)   |       |
+|                        | PINCER |   1 (  3.8)   |   4 ( 15.4)   |       |
+|                        | MISTO  |   5 ( 19.2)   |   6 ( 23.1)   |       |
+
+Table: **Tabela 2** Descrição das mensurações avaliadas e os tipos de impacto em cada lado do quadril.
+sd = Desvio padrão,
+ALFA = ângulo alfa,
+IA = índice acetabular,
+ACB = ângulo centro-borda acetabular,
+EXTRU = índice de extrusão.
+p = teste t de Student para variáveis contínuas, e teste exato de Fisher para impacto.
+
+Observou-se que, na média, o ângulo alfa foi significativamente maior no lado direito dos pacientes que o medido no lado esquerdo (Tabela 2).
+As outras mensurações parecem ser homogeneamente distribuídas em ambos os lados.
+O mesmo ocorre com a distribuição de frequências doso tipos de impacto em ambos os quadris de cada paciente.
+
+<!-- ## Características de cada gênero -->
 
 
 |        &nbsp;         |  level  |      F       |      M       |   p    |
 |:---------------------:|:-------:|:------------:|:------------:|:------:|
 |         **n**         |         |      7       |      19      |        |
-|     **SEXO (%)**      |    F    |  7 (100.0)   |  0 (  0.0)   | <0.001 |
-|                       |    M    |  0 (  0.0)   |  19 (100.0)  |        |
 | **IDADE (mean (sd))** |         | 35.00 (6.38) | 35.00 (6.98) | 1.000  |
-|     **RACA (%)**      | Outros  |  0 (  0.0)   |  7 ( 36.8)   | 0.134  |
-|                       | Branca  |  7 (100.0)   |  12 ( 63.2)  |        |
 |  **IMC (mean (sd))**  |         | 19.54 (2.44) | 25.67 (3.36) | <0.001 |
 |      **DOR (%)**      |    D    |  4 ( 57.1)   |  9 ( 47.4)   | 0.603  |
 |                       |    E    |  0 (  0.0)   |  4 ( 21.1)   |        |
@@ -163,63 +170,54 @@ Table: Tabela por lado da medição
 |                       |    E    |  0 (  0.0)   |  2 ( 10.5)   |        |
 |                       |    B    |  2 ( 28.6)   |  3 ( 15.8)   |        |
 
-Table: Tabela por genero
-
-
-|        &nbsp;         |  level  |      D       |      E       |      B       |   p    |
-|:---------------------:|:-------:|:------------:|:------------:|:------------:|:------:|
-|         **n**         |         |      13      |      4       |      9       |        |
-|     **SEXO (%)**      |    F    |  4 ( 30.8)   |  0 (  0.0)   |  3 ( 33.3)   | 0.603  |
-|                       |    M    |  9 ( 69.2)   |  4 (100.0)   |  6 ( 66.7)   |        |
-| **IDADE (mean (sd))** |         | 35.23 (8.08) | 33.75 (6.24) | 35.22 (5.17) | 0.927  |
-|     **RACA (%)**      | Outros  |  3 ( 23.1)   |  2 ( 50.0)   |  2 ( 22.2)   | 0.697  |
-|                       | Branca  |  10 ( 76.9)  |  2 ( 50.0)   |  7 ( 77.8)   |        |
-|  **IMC (mean (sd))**  |         | 24.24 (4.85) | 24.35 (2.76) | 23.57 (3.91) | 0.925  |
-|      **DOR (%)**      |    D    |  13 (100.0)  |  0 (  0.0)   |  0 (  0.0)   | <0.001 |
-|                       |    E    |  0 (  0.0)   |  4 (100.0)   |  0 (  0.0)   |        |
-|                       |    B    |  0 (  0.0)   |  0 (  0.0)   |  9 (100.0)   |        |
-|      **CAM (%)**      |    N    |  2 ( 15.4)   |  1 ( 25.0)   |  1 ( 11.1)   | 0.147  |
-|                       |    D    |  4 ( 30.8)   |  0 (  0.0)   |  2 ( 22.2)   |        |
-|                       |    E    |  0 (  0.0)   |  2 ( 50.0)   |  0 (  0.0)   |        |
-|                       |    B    |  7 ( 53.8)   |  1 ( 25.0)   |  6 ( 66.7)   |        |
-|    **PINCER (%)**     |    N    |  4 ( 30.8)   |  1 ( 25.0)   |  4 ( 44.4)   | 0.711  |
-|                       |    D    |  3 ( 23.1)   |  1 ( 25.0)   |  0 (  0.0)   |        |
-|                       |    E    |  1 (  7.7)   |  1 ( 25.0)   |  1 ( 11.1)   |        |
-|                       |    B    |  5 ( 38.5)   |  1 ( 25.0)   |  4 ( 44.4)   |        |
-|     **MISTO (%)**     | Simples |  6 ( 46.2)   |  3 ( 75.0)   |  6 ( 66.7)   | 0.237  |
-|                       |    D    |  4 ( 30.8)   |  0 (  0.0)   |  0 (  0.0)   |        |
-|                       |    E    |  1 (  7.7)   |  1 ( 25.0)   |  0 (  0.0)   |        |
-|                       |    B    |  2 ( 15.4)   |  0 (  0.0)   |  3 ( 33.3)   |        |
-
-Table: Tabela por lado da dor
-
-
-|        &nbsp;         |  level  |    Outros    |    Branca    |   p    |
-|:---------------------:|:-------:|:------------:|:------------:|:------:|
-|         **n**         |         |      7       |      19      |        |
-|     **SEXO (%)**      |    F    |  0 (  0.0)   |  7 ( 36.8)   | 0.134  |
-|                       |    M    |  7 (100.0)   |  12 ( 63.2)  |        |
-| **IDADE (mean (sd))** |         | 37.57 (7.41) | 34.05 (6.36) | 0.243  |
-|     **RACA (%)**      | Outros  |  7 (100.0)   |  0 (  0.0)   | <0.001 |
-|                       | Branca  |  0 (  0.0)   |  19 (100.0)  |        |
-|  **IMC (mean (sd))**  |         | 26.70 (3.30) | 23.04 (4.06) | 0.043  |
-|      **DOR (%)**      |    D    |  3 ( 42.9)   |  10 ( 52.6)  | 0.697  |
-|                       |    E    |  2 ( 28.6)   |  2 ( 10.5)   |        |
-|                       |    B    |  2 ( 28.6)   |  7 ( 36.8)   |        |
-|      **CAM (%)**      |    N    |  1 ( 14.3)   |  3 ( 15.8)   | 0.909  |
-|                       |    D    |  1 ( 14.3)   |  5 ( 26.3)   |        |
-|                       |    E    |  1 ( 14.3)   |  1 (  5.3)   |        |
-|                       |    B    |  4 ( 57.1)   |  10 ( 52.6)  |        |
-|    **PINCER (%)**     |    N    |  4 ( 57.1)   |  5 ( 26.3)   | 0.615  |
-|                       |    D    |  1 ( 14.3)   |  3 ( 15.8)   |        |
-|                       |    E    |  0 (  0.0)   |  3 ( 15.8)   |        |
-|                       |    B    |  2 ( 28.6)   |  8 ( 42.1)   |        |
-|     **MISTO (%)**     | Simples |  5 ( 71.4)   |  10 ( 52.6)  | 1.000  |
-|                       |    D    |  1 ( 14.3)   |  3 ( 15.8)   |        |
-|                       |    E    |  0 (  0.0)   |  2 ( 10.5)   |        |
-|                       |    B    |  1 ( 14.3)   |  4 ( 21.1)   |        |
-
-Table: Tabela por raça
+Table: **Tabela 3** Mensurações avaliadas e tipos de impacto observados por gênero.
+sd = Desvio padrão,
+IMC = Índice de massa corpórea,
+p = teste t de Student para variáveis contínuas, e teste exato de Fisher para impacto.
+
+O IMC médio dos homens é significativamente maior que o das mulheres (tabela 3).
+A idade média, lado doloroso e o tipo de impacto dos participantes de cada gênero apresentou boa homogeneidade.
+
+<!-- ## Características pelo lado doloroso -->
+
+
+|        &nbsp;         |  level  |      D       |      E       |      B       |   p   |
+|:---------------------:|:-------:|:------------:|:------------:|:------------:|:-----:|
+|         **n**         |         |      13      |      4       |      9       |       |
+| **IDADE (mean (sd))** |         | 35.23 (8.08) | 33.75 (6.24) | 35.22 (5.17) | 0.927 |
+|  **IMC (mean (sd))**  |         | 24.24 (4.85) | 24.35 (2.76) | 23.57 (3.91) | 0.925 |
+|      **CAM (%)**      |    N    |  2 ( 15.4)   |  1 ( 25.0)   |  1 ( 11.1)   | 0.147 |
+|                       |    D    |  4 ( 30.8)   |  0 (  0.0)   |  2 ( 22.2)   |       |
+|                       |    E    |  0 (  0.0)   |  2 ( 50.0)   |  0 (  0.0)   |       |
+|                       |    B    |  7 ( 53.8)   |  1 ( 25.0)   |  6 ( 66.7)   |       |
+|    **PINCER (%)**     |    N    |  4 ( 30.8)   |  1 ( 25.0)   |  4 ( 44.4)   | 0.711 |
+|                       |    D    |  3 ( 23.1)   |  1 ( 25.0)   |  0 (  0.0)   |       |
+|                       |    E    |  1 (  7.7)   |  1 ( 25.0)   |  1 ( 11.1)   |       |
+|                       |    B    |  5 ( 38.5)   |  1 ( 25.0)   |  4 ( 44.4)   |       |
+|     **MISTO (%)**     | Simples |  6 ( 46.2)   |  3 ( 75.0)   |  6 ( 66.7)   | 0.237 |
+|                       |    D    |  4 ( 30.8)   |  0 (  0.0)   |  0 (  0.0)   |       |
+|                       |    E    |  1 (  7.7)   |  1 ( 25.0)   |  0 (  0.0)   |       |
+|                       |    B    |  2 ( 15.4)   |  0 (  0.0)   |  3 ( 33.3)   |       |
+
+Table: **Tabela 4** Descrição dos participantes quanto ao lado doloroso.
+sd = Desvio padrão,
+IMC = Índice de massa corpórea,
+p = teste t de Student para variáveis contínuas, e teste exato de Fisher para impacto.
+
+Não houve associação significativa entre idade, IMC ou a dsitribuição dos tipos de impacto e o lado doloroso (Tabela 4).
+
+Além disso, os participantes brancos e de outras raças tem distribuições semelhantes de gênero
+(p = 0.1338),
+idade 
+(p = 0.2929).
+Os participantes brancos tem IMC ligeiramente menor que de outras raças
+(p = 0.03479).
+Não houve diferença entre os participants brancos e de outras raças quanto à observação de CAM
+(p = 0.9087),
+PINCER
+(p = 0.6153)
+ou impacto MISTO
+(p = 1).
 
 ## Frequências dos impactos
 
@@ -241,9 +239,11 @@ Table: Impactos CAM x PINCER, p-value = 0.2631
 
 Table: Impactos CAM x PINCER, levando em conta lateralidade p-value = 0.1918
 
-Há 2 pacientes que tem simultaneamente CAM e PINCER, mas em lados diferentes (1 paciente tem CAM D e PINCER E, e o outro tem CAM E e PINCER D).
+Há 2 participantes que tem simultaneamente CAM e PINCER, mas em lados diferentes (1 participante tem CAM D e PINCER E, e o outro tem CAM E e PINCER D).
 Por isso, não são contabilizados como casos de impacto MISTO.
 
+![](../figures/painel_dor.png)
+
 ## Por sexo
 
 Os impactos ocorrem de forma diferenciada por sexo?
@@ -306,10 +306,12 @@ Table: PINCER p-value = 0.06238
 
 Table: MISTO p-value = 1.000
 
+![](../figures/painel_sex_lat.png)
+
 
 ## Por lado de dor
 
-O impacto é um bom preditor para em que lado o paciente sente dor?
+O impacto é um bom preditor para em que lado o participante sente dor?
 
 ### Geral
 
@@ -369,6 +371,8 @@ Table: PINCER p-value = 0.5243
 
 Table: MISTO p-value = 0.1333
 
+![](../figures/painel_dor_lat.png)
+
 <!-- # Exceções e Desvios do teste -->
 
 # Conclusões