Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Rastreamento"

Navegando por Palavras-chave "Rastreamento"

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Acesso aberto (Open Access)
Abrangência da política de detecção precoce de câncer de mama no Brasil
(Universidade Federal de São Paulo, 2024-08-30) Souza, Isabella Ferreira de [UNIFESP]; Fonseca, Fernando Luiz Affonso [UNIFESP]; http://lattes.cnpq.br/6772382797320564
Este trabalho aborda os desafios encontrados na cobertura do rastreamento de câncer de mama no Brasil. O rastreamento do câncer de mama com mamografia é uma importante estratégia para a detecção precoce da doença. Com dados coletados do Sistema de Informação do Câncer (SISCAN), foram observadas diferenças significativas na realização de mamografias entre as regiões brasileiras e entre os níveis de a escolaridade que podem ser fatores determinantes para a adesão ao exame, assim como o período de coleta analisado. Ademais, a forma de coleta dos dados também pode impactar nos números disponibilizados. A conscientização da população sobre a importância da mamografia e a capacitação dos profissionais de saúde são fundamentais para aumentar a cobertura do exame. Portanto, é necessário investir em estratégias de conscientização e em uma rede de atenção à saúde preparada para acolher as mulheres com sinais e sintomas suspeitos, garantindo a investigação e o tratamento adequados dos casos confirmados.
Acesso aberto (Open Access)
Avaliação da qualidade da ultrassonografia tridimensional mediante as técnicas Fast, Star e Five D-Heart no rastreamento das doenças cardíacas congênitas
(Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Carrilho, Milene Carvalho [UNIFESP]; Araujo Junior, Edward [UNIFESP]; Universidade Federal de São Paulo
Objective: To compare the quality of standard fetal echocardiographic views obtained by three-dimensional ultrasound with those obtained by the simple targeted arterial rendering (STAR) technique, four-chamber view swing technique (FAST), and fetal intelligent navigation echocardiography (FINE / 5D-Heart®) technique. Methods: This was a cross-sectional prospective study that included pregnant women between 22 and 34 weeks of gestation, with normal fetuses. Fetal heart volumes were acquired using spatio-temporal image correlation (STIC) with the fetal spine between 2 and 9 o’clock. The FAST/STAR techniques consist of the manipulation of STIC volumes by drawing OmniView® lines to obtain echocardiographic views. The FINE technique uses intelligent navigation to automatically generate echocardiographic views. The quality of the images was classified as excellent, good, acceptable, and unacceptable. The analysis was performed using the Bonferroni multiple-comparisons test. Results: The study included 101 pregnant women aged between 16 and 44 years (mean ± standard deviation of 32 ± 6.3) at a gestational age of 20 to 34 weeks (mean ± standard deviation of 26 ± 4.2). There was no mean difference in image quality between fetal spine positions in all views (p>0.05). However, in the five-chamber, left ventricular outflow tract, right ventricular outflow tract, ductal arch, superior vena cava/inferior vena cava, and abdomen/stomach views, there was a statistically significant mean difference between the techniques of reconstruction of the standard echocardiographic views, regardless of the spine position (p<0.05). The best mean image quality was obtained by the FINE technique. Conclusion: The quality of the echocardiographic views obtained using the FINE/5D-Heart® technique was superior to that of those generated by the FAST/STAR techniques in normal fetuses scanned between 20 and 34 weeks of gestation.
Acesso aberto (Open Access)
Avaliação do desfecho dos conceptos com risco aumentado de ocorrência de anomalias cromossômicas calculado pela medida da translucência nucal
(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2005-03-01) Camano, Luiz [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Pares, David Baptista da Silva [UNIFESP]; Chinen, Paulo Alexandre [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: to evaluate the outcome of fetuses with risk of chromosomal anomalies over 1:300, based on the nuchal translucency measurement, according to the Fetal Medicine Program. METHODS: in the pregnancies with risk of chromosomal anomalies over 1:300, variables like fetal karyotype, spontaneous or induced abortion, prematurity, stillbirth, neonatal death, malformations, and healthy newborn were considered. We used Fisher's exact test to compare differences in proportions between groups. RESULTS: we selected 193 (3.6%) single pregnancies with risk of chromosomal anomalies over 1:300. Only 165 cases fulfilled the inclusion criteria. Of these only 32.1% underwent fetal karyotyping and of which 8.5% had chromosomal anomalies (85.7% had trisomy 21). Regarding pregnancy outcomes, 4.2% were spontaneous miscarriages, 4.2% induced abortions, 4.8% were premature, 1.8% had neonatal death, 1.8% were stillborn, and 4.2% had structural malformation (85.7% congenital heart diseases). Almost 85.0% were healthy newborns. Patients with abnormal karyotyping had more induced abortions (p<0.001) and more structural malformations (p<0.001) than patients with normal karyotyping. None of the genetic diseases or miscarriages was associated with invasive procedures. Sixty-six percent of the pregnancies with prenatal diagnosis of abnormal karyotype were interrupted. CONCLUSION: nuchal translucency is an important screening tool for chromosomal diseases especially for low-risk pregnancies. However, counseling pregnancies with high risk of chromosomal anomalies should consider that, although these fetuses have a worse prognosis, most of the outcomes are favorable.
Acesso aberto (Open Access)
Central de ultrassom: proposta de rastreamento de malformações cardíacas fetais
(Universidade Federal de São Paulo (UNIFESP), 2016-07-12) Barros, Lidiane Pereira dos Reis [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; http://lattes.cnpq.br/6569055379421505; http://lattes.cnpq.br/2154399933069784; Universidade Federal de São Paulo (UNIFESP)
Objective: To elaborate a proposal to assist in the identification of fetal cardiac malformations by creating an model Ultrasound Central to be designed in conjunction with a medical training methodology and a computational tool that allows the transmission of fetal heart images through Internet, acquired during obstetric exam or morphological ultrasound performed in a healthcare facility to one or more centers, formed by specialists in fetal cardiology, to assist on the diagnosis. Methods: For the development, the work was organized in three blocks: Research and Development, Methodology and Technological Solution. In block one: Research and Development, the project was conceived and the requirements determined. In block two: Methodology, establishment of a methodology to train obstetricians in the identification of fetal cardiac malformations, through medical training and in block three: Technological Solution, implementation of a system for the operation of the Ultrasound Central and its requirements. Results: Block one results were achieved through the possibility of using various types of ultrasound equipment in the solution, including analogue ones, and allowing the compression of the exams without losing the quality needed for report elaboration. In block two, a training program was developed to train physicians in the recognition of fetal heart malformations and system usage, and in block three, the creation of a viable product to fulfils the flow of the processes designed for the solution, such as, sending of morphological obstetric ultrasound examinations on the Internet, to a central with specialists in ecocardiofetal issue a second opinion of the report or guidance for the accomplishment of the examination, tools for image analysis to evaluate the exam, among others. Conclusion: The three objectives proposed in the thesis were attended, in the spheres of elaboration of the Ultrasound Central model, creation of the methodology to help the identification of fetal cardiac malformations and implementation of the computational tool.
Acesso aberto (Open Access)
Comparação entre duas estratégias para a detecção precoce do hipotiroidismo congênito
(Associação Médica Brasileira, 1998-06-01) Ward, Laura Sterian [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Kunii, Ilda.Sizue [UNIFESP]; Furuzawa, Gilberto Koiti [UNIFESP]; Matsumura, Luiza Kimiko [UNIFESP]; Vieira, Jose Gilberto Henriques [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: Compare two different strategies in newborn screening for congenital hypothyroidism, primary TSH in the umbilical cord blood (method 1) and primary T4 in blood collected from the heel in the 2nd day of life (method 2). METHODS: We compared both strategies in 10,000 newborns, measuring TSH by a sensitive immunofluorimetric assay and T4 by a radioimmunoassay. RESULTS: Both strategies detected all cases of hypothyroidism (4 cases, 1/2,500 newborns). The recalling index owing to insufficient amount of blood to perform the assays was zero in method 1 and 8.5% (850 newborns) in method 2. The recalling index for confirmation of the results was 0.06% (6 newborns) in method 1 and 2.25% (225 newborns) in method 2; when method 2 included supplementary TSH, the recalling index was reduced to 1.63% (163 newborns). CONCLUSION: Our data indicate the technical superiority of the umbilical cord blood compared to heel and primary TSH compared to primary T4 in the neonatal thyroid screening for congenital hypothyroidism.
Acesso aberto (Open Access)
Deficiência da Lipase Ácida Lisossômica (LAL-D): uma causa subdiagnosticada de dislipidemia e alterações da função hepática
(Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Brasil, Zenia [UNIFESP]; Izar, Maria Cristina De Oliveira [UNIFESP]; Universidade Federal de São Paulo
Lysosomal acid lipase (LAL) is the enzyme encoded by the LIPA gene; deficiency of this enzyme leads to a congenital lysosomal disorder called Lysosomal Acid Lipase Deficiency (LAL-D). LAL is essential for lipid metabolism as it is responsible for the hydrolysis of the esters of cholesterol of low-density lipoprotein (low-density lipoprotein, LDL-c) and triglycerides, generating cholesterol and free fatty acids that are involved in the regulation of homeostasis of the cholesterol. The deficiency of this enzyme leads to the accumulation of lysosomal esters of cholesterol and triglyceride and eventually failure of the LDL-c receptor pathway. Despite the massive accumulation of cholesterol esters by lysosomes, there is an increase in cellular cholesterol synthesis. LAL-D (OMIM # 278000) is a disease of genetic origin, autosomal recessive, caused by mutations in the LIPA gene (OMIM 613497), mapped on the long arm of chromosome 10 (10q23.2-q23.3) and containing 10 exons. Classically, it has two phenotypes, Wolman Disease (WD) and Cholesterol Ester Storage Disease (CESD). WD is a fulminant subtype with absence or less than 1% of LAL activity manifesting in the neonatal period, which can lead to death in the first year of life. CESD has a later presentation, but may be present in childhood and adulthood, depending on the residual activity of LAL, which may vary from 1% to 12% of normal. Dyslipidemia, liver dysfunction, hepatomegaly, hepatosplenomegaly are the main features of this lysosomal disorder. There is specific therapy with enzyme replacement that partially reverses or delays the complications of the disease. Objectives: to investigate the prevalence of Lysosomal Acid Lipase Deficiency in a risk population attended at the outpatient clinics of the Lipids, Atherosclerosis and Vascular Biology Section, Cardiology Division of the Federal University of São Paulo (UNIFESP) based on clinical and laboratory criteria. Methods: Retrospective study evaluated two-thousand consecutive medical records of adult and pediatric patients treated at outpatient clinics of a single center for dyslipidemia. Selective screening criteria for LAL-D included LDL-C> 160 mg / dL, HDL-C <40 or <50 mg / dL in men and women, respectively, AST and / or ALT> 1.5 x upper normal limit, presence of liver steatosis by ultrasound or biopsy, and mutation in the LIPA gene. For patients on lipid-lowering therapy, LDL-C was corrected according to the intensity of treatment. Patients who met the LAL-D criteria underwent LAL activity testing by enzymatic fluorescent method to analyze lysosomal acid lipase activity using a specific enzyme inhibitor that enables the evaluation in dry blood spot in filter paper. Results: Among the 2000 screened subjects we found 21 patients who met the LAL-D suspicion criteria, being nine males, 12 females, ages between 23 and 82 years old. The most prevalent screening criteria were ALT > 1.5 x upper normal limit in 100% of patients, while the HDL-C and the liver enzyme AST > 1.5 x upper normal limit was observed in 36.36 % of patients. No LAL deficiency was found by the LAL activity test, suggesting that this condition is very rare, even in services that serve a population at risk. Conclusions: Although clinical and laboratory criteria have been used to screen for LAL-D, the condition is very rare, even in services that serve a population at risk. Early diagnosis of LAL-D is critical to enable nutritional, lifestyle, and specific therapeutic guidance to alleviate or delay disease course and complications.
Acesso aberto (Open Access)
Detecção da retinopatia diabética no Diabetes Mellitus Tipo 1: comparação entre a oftalmoscopia binocular indireta e a retinografia digital em um estudo populacional. Alterações na espessura da coroide em pacientes com Diabetes Mellitus Tipo 1 sem retinopatia
(Universidade Federal de São Paulo (UNIFESP), 2016-08-31) Malerbi, Fernando Korn [UNIFESP]; Dib, Sergio Atala [UNIFESP]; http://lattes.cnpq.br/3659437526996462; http://lattes.cnpq.br/8724599579159084; Universidade Federal de São Paulo (UNIFESP)
Article 1 Background. Diabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Diabetic retinopathy screening is effective in preventing blindness and can be performed through various diagnostic methods. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country. Methods. Data from 1266 Type 1 Diabetes Mellitus patients from a Brazilian multicenter study were analyzed. Patients underwent BIO and digital retinography, non-mydriatic and mydriatic. Images were sent to a reading center in a telemedicine protocol. Agreement between the different methods was calculated with kappa statistic for diabetic retinopathy and maculopathy classification. Clinical outcome was either observation or referral to specialist. Results. Agreement between BIO and mydriatic retinography was substantial (kappa = 0.67 to 0.74) for diabetic retinopathy observation vs referral classification. Agreement was fair to moderate (kappa = 0.24 to 0.45) between retinography and BIO for maculopathy. Poor mydriasis was the main obstacle to image reading and classification, especially on the nonmydriatic strategy, occurring in 11.9% or right eyes and 16.9% of left eyes. Conclusion. Mydriatic retinography showed a substantial agreement to BIO for diabetic retinopathy observation vs referral classification. A significant amount of information was lost on the non-mydriatic technique because of poor mydriasis. We recommend a telemedicine-based diabetic retinopathy screening strategy with digital mydriatic retinography, preferably with 2 fields (macula- and optic disc-centered), and advise against non-mydriatic retinography in developing countries. Article 2 BACKGROUND/AIMS: To examine tomographic measurements of choroidal thickness in normoalbuminuric and albuminuric Type 1 diabetes mellitus (T1D) patients without diabetic retinopathy. METHODS: Cross-sectional study. Forty T1D patients without diabetic retinopathy were evaluated by spectral domain optical coherence tomography (SD-OCT); twenty-four agematched healthy subjects were evaluated as a control group. Patients with diabetes were classified into 2 groups: 19 patients were albuminuric and 21were normoalbuminuric. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-?m intervals up to 1000 ?m temporal and nasal to the fovea. RESULTS: Mean choroidal thickness was increased in patients with diabetes. Albuminuric diabetic patients had a thicker subfoveal choroid in comparison to normoalbuminuric diabetic patients (390?m versus 361?m), and subfoveal CT of both groups of diabetic patients was increased in comparison to the control group (323?m). Analysis of variance showed significant differences subfoveally and at the nasal points (p<0.05). CONCLUSIONS: Albuminuric T1D patients without diabetic retinopathy presented a thickened choroid. SD-OCT evaluation of the choroid revealed significant thickness changes even before diabetic retinopathy was present. An altered CT may be a surrogate for the systemic vascular changes that occur in diabetes, and albuminuria should be acknowledged as a confounding factor in the evaluation of choroidal thickness in diabetic patients.
Acesso aberto (Open Access)
Estudo do perfil demográfico e do risco tromboembólico associados à fibrilação atrial na atenção básica do sistema único de saúde brasileiro utilizando-se a tecnologia da telemedicina
(Universidade Federal de São Paulo (UNIFESP), 2018-12-10) Moraes, Eraldo Ribeiro Ferreira Leao de [UNIFESP]; Paola, Angelo Amato Vincenzo de [UNIFESP]; http://lattes.cnpq.br/6259836166380719; http://lattes.cnpq.br/8936079749176279; Universidade Federal de São Paulo (UNIFESP)
Background: The worldwide prevalence of atrial fibrillation (AF) varies between 0.1% and 4.0% and has been increasing. Little is known about the prevalence, stroke risk assessment and treatment of AF in Brazil. Methods: Our objective was to estimate the general prevalence of AF in several regions of Brazil using recordings of longdistance electrocardiogram (ECG) transmission. Patients from 125 outpatient general practitioner units covered by the telemedicine service of the Federal University of São Paulo were included. Only one ECG was considered per patient. A scripted telephone interview was also performed. Using the Brazilian Institute of Geography and Statistics (IBGE) method, we analyzed the data to project the prevalence of AF in the Brazilian population and estimate it for the year 2025. Results: Based on 676,621 ECG exams from January 2009 through April 2016, the mean age (±SD) of patients was 51.4 (±19.1) years, with 57.5% being female. The 7year period prevalence of AF was 2.2% (n=14,968). Based on the IBGE method, the prevalence of AF countrywide was projected to be 1.5% in 2016 and 1.7% in 2025. In the subset of patients with AF who were interviewed (n=301), 91 (30.2%) were not receiving any type of treatment for rate or rhythm control. Overall, 136 (64.7%) of the patients were on acetylsalicylic acid alone, 39 (18.7%) were using oral anticoagulants (OACs), and 7 (3.3%) reported concomitant use of acetylsalicylic acid and an OAC. Among patients interviewed, 189 (62.8%) were at high risk for stroke; only 28 (14.8%) were regular OAC users. Conclusions: Our study highlights the importance of screening for AF in the primary care setting in Brazil and identifies important gaps in the treatment of AF in this population.
Embargo
Mapeamento da utilização do Breast Imaging Reporting and Data System (BI-RADS®) na ultrassonografia no Brasil
(Universidade Federal de São Paulo, 2024-11-26) Merjane, Vanessa [UNIFESP]; Iared, Wagner [UNIFESP]; Bitencourt, Almir Galvão Vieira; http://lattes.cnpq.br/9831557351263462; http://lattes.cnpq.br/0900714290963020; http://lattes.cnpq.br/2695339990281349
Introdução: O BI-RADS® é uma ferramenta de qualidade criada pelo ACR. Denominado sistema por conter um léxico, estrutura de relatórios e coleta de dados / monitoramento de resultados. A US é um dos principais métodos de diagnóstico de doenças mamárias, junto com mamografia, RM e biópsia guiada por imagem. Objetivos: O objetivo principal desta pesquisa é mapear o uso do BI-RADS® na US no Brasil. Os objetivos secundários buscam investigar o perfil dos médicos que utilizam o BI-RADS®, avaliar sua dinâmica de trabalho e identificar problemas e particularidades na prática diária da US mamária no país que possam influenciar a utilização desse sistema. Métodos: Aplicado questionário on-line e individual a uma amostra de médicos. A divulgação do link, com 58 perguntas de múltipla escolha, foi realizada entre setembro/2022 e fevereiro/2023, em congressos médicos, redes sociais e e-mails cadastrados nas entidades: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, Sociedade Brasileira de Mastologia, Federação Brasileira das Associações de Ginecologia e Obstetrícia, Sociedade Brasileira de Ultrassonografia e Associação Médica Brasileira. Todos os dados foram submetidos a análise estatística descritiva por meio de frequências absolutas e relativas, utilizando-se o software R. Resultados: Foram analisadas respostas de 686 médicos de todos os estados brasileiros e Distrito Federal, sendo 355 (51,7%) da Região Sudeste, 398 (58,0%) com atuação nas capitais/região metropolitana, 417 (60,8%) mulheres e 241 (35,1%) entre 31-40 anos, sendo 293 (42,7%) formados há mais de 20 anos. Do total, 348 (50,7%) atuam exclusivamente no setor privado, 31 (4,5%) no setor público e 307 (44,8%) nos dois setores, sendo que 577 (84,1%) atuam a maior parte do tempo no privado. Destacamos que 282 (41,1%) não fizeram residência reconhecida pela Comissão Nacional de Residência Médica. Entre os 588 médicos (85,7%) com Título de Especialista, identificamos 279 (40,7%) com especialização específica em Radiologia e Diagnóstico por Imagem. Entre os respondentes, 364 (53,1%) atuam exclusivamente com US, ou seja, não realizam outro método de imagem da mama. Apesar de 99,1% dos médicos afirmarem utilizar o BI-RADS® na prática diária, sobre a forma de como utilizam o sistema nos relatórios, apenas 360 (52,5%) afirmaram sempre colocar a indicação do exame e 355 (51,8%) sempre incluir recomendação de conduta. Em relação ao monitoramento dos resultados, apenas 66 (9,6%) afirmaram que são realizadas auditorias institucionais com comprovação histopatológica dos casos. Do total de respondentes, 238 médicos (34,7%) afirmaram trabalhar sem acesso a um Picture Archiving and Communication System (PACS). A maioria dos médicos, 526 (76,7%), trabalha em sistema de agenda mista, que envolve outros tipos de exames ultrassonográficos, que não a US mamária, e 267 (38,9%) respondentes afirmaram trabalhar em instituições onde não há obrigatoriedade da realização da mamografia antes da US, quando os dois exames são solicitados juntos. Conclusões: O estudo destaca que o BI-RADS® é amplamente utilizado pelos médicos – que realizam US mamária no Brasil – que têm compreensão da sua responsabilidade individual. A falta de aplicação de critérios necessários para a sua utilização na US indicam fragilidades na implementação do sistema no contexto brasileiro. Além disso, verificamos heterogeneidade e fragmentação do ensino médico, das habilidades profissionais e da rotina de trabalho destes médicos que aplicam o BI-RADS®, o que pode contribuir para inconsistências na implementação e uso do sistema na prática clínica.
Somente Metadadados
Predição Da Pre Eclampsia No Primeiro Trimestre Utilizando As Seguintes Variáveis: Características Maternas, Pressão Arterial Média E Dopplervelocimetria Das Artérias Uterinas
(Universidade Federal de São Paulo (UNIFESP), 2018-02-22) Leite, Juliana De Freitas [UNIFESP]; Pares, David Baptista Da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective: To Evaluate The Performance Of Preeclampsia (Pe) Screening In The First Trimester Of Fmf (Fetal Medicine Foundation " London) In A Sample Of Brazilian Population By The Variables Analysis: Maternal Characteristics, Mean Arterial Pressure (Map) And Uterine Artery Doppler Velocimetry. Methods: It Is A Retrospective Analysis Of A Prospective Observational Study, Which Originally Evaluated 701 Pregnant Women In The Morphological Exams Of First Trimester. Ninety-Six Patients Were Excluded, So We Evaluated The Data Of 605 Patients. Information Regarding Clinical And Obstetric History, Map And Mean Uterine Artery Pulsatility Index (Mean Pi) Were Obtained From All Patients. These Variables Were Insert Into Fmf Program And The Risks Of Pe Were Calculated For Each Patient. Four Groups Were Organized In Accordance With Gestational Age At Delivery For Pe. Group 1 (Control): Patients Without Hypertensive Disorders (N=571). Group 2: Delivery Before 34 Weeks" Gestation (N=7). Group 3: Delivery Before 37 Weeks" Ge
Acesso aberto (Open Access)
Rastreamento visual em crianças da educação infantil e ensino fundamental 1: acuidade visual, motilidade extrínseca ocular e acuidade estereoscópica
(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Quercia, Andressa Zanini Fantato [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Ferraz, Nivea Nunes [UNIFESP]; http://lattes.cnpq.br/0768359963029007; http://lattes.cnpq.br/7387176261076209; http://lattes.cnpq.br/1336685192142760; Universidade Federal de São Paulo (UNIFESP)
Objective: Screening programs for visual problems in childhood provide access for the child population to ophthalmological assessment and thus enable the detection of eye diseases and the prevention of visual impairment and blindness in childhood. The objective of this work was to analyze the results of visual acuity, extrinsic ocular motility and stereoscopic acuity of children in Early Childhood Education and Elementary School I evaluated in the Eye Health Promotion Program held at Escola Paulistinha de Educação. Methods: This cross-sectional, retrospective observational study was carried out based on the review of medical records of children attended from 1992 to 2017. Visual acuity (VA) data presented monocular far (cortical in the Snellen table or angular with optotype “E” of Snellen / Sjogren's “hand”), state of ocular extrinsic motility (MEO) and stereoscopic acuity (LA) were tabulated. Medical records without information on date of birth, visual acuity or state of extrinsic ocular motility were excluded. For data analysis, the AV values obtained in decimal were converted into logMAR and the participants were grouped into three age groups (<6 years, ≤ 6 to 9 years and> 9 years). The level of statistical significance was considered as P≤0.05. Results: From the total of 1922 reviewed medical records, data from 1705 students (50.21% female) were included, ranging in age from 2 years and 5 months to 12 years and 2 months (mean = 5.16 ± 1.76 years). The VA presented in the eye with the best vision varied from 0.00 to 0.70 logMAR (mean = 0.03 ± 0.07 logMAR) and was better in children older than 9 years. The AE varied from 40 to 800 seconds of arc (mean 108 ± 160 seconds of arc) and was better in children from 6 years of age. Two hundred and thirty-six (13.84%) students had some degree of visual impairment (VA ≤0.16logMAR or 0.7) in one or both eyes. Alteration of the MEO was observed in 44 students (59.09% with manifest strabismus and 40.91% with intermittent strabismus), with manifest esotropia being present in 50% of the cases. Of the total of 1705 examined, 417 referrals were made to the eye service, mainly due to visual impairment. Conclusions: Visual and stereoscopic acuity were better in children from 6 years of age. The frequency of low vision in at least one eye was 13.84% and strabismus, 2.58%. In general, visual screening enabled early referral to ophthalmological assessment, positively impacting school learning and children's quality of life.
Acesso aberto (Open Access)
Testes de rastreamento x testes de diagnóstico: atualidades no contexto da atuação fonoaudiológica
(Pró-Fono Produtos Especializados para Fonoaudiologia Ltda., 2007-06-01) Goulart, Bárbara Niegia Garcia de [UNIFESP]; Chiari, Brasilia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Feevale
BACKGROND: evaluation instruments, properties, selection indicators, application and validation of screening and diagnostic tests. AIM: to present some concepts concerning screening and diagnostic tests and their application according to a specific purpose. To present a few practical examples of the application of these instruments related to human communication, as well as to present validation criteria of tests in the population and criteria used for the rational selection of screening or diagnostic instruments in health programs and health services based on epidemiological concepts indexed in Scielo, Lilacs or Medline up to January 2007. CONCLUSION: diagnostic instruments differ from screening instruments in their objectives and eligibility criteria. Sensibility and specificity are two important indicators to be considered when choosing an instrument for screening or diagnosis. Reproducibility, time required to complete the evaluation and previous preparation of patients, if needed, are also indicators to be considered when choosing an instrument. Publication and information exchange regarding the properties of evaluation instruments, used for diagnosis or screening, related to the Speech, Language and Hearing Sciences must be systematically stimulated. Besides that, improving the knowledge about methodologies and evaluation instruments under different perspectives contribute to the better use of human and financial resources. Furthermore, the elaboration of studies that promote the correct validation of screening and diagnostic instruments used in human communication disorders contributes to the increase in knowledge in the field of Speech, Language and Hearing Sciences and, indirectly, to the acknowledgement of this science, based on technical-scientific evidence, in health promotion.
Acesso aberto (Open Access)
Thyroid stimulating hormone levels in cord blood are not influenced by non-thyroidal mothers' diseases
(Associação Paulista de Medicina - APM, 2000-09-07) Ward, Laura Sterian; Kunii, Ilda Shizue [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)
CONTEXT: Screening programs not only offer the opportunity to trace and treat almost all cases of congenital hypothyroidism but also mean large savings to the health system. However, carefully planned strategies are necessary to extend their benefits and reduce costs. OBJECTIVE: To determine the possible influence of maternal diseases that affect maternal-fetal placenta dynamics on primary thyroid stimulating hormone (TSH) screening for congenital hypothyroidism. DESIGN: Prospective non-randomized clinical trial with at least 3 months of follow-up. SETTING: A public university referral center [CAISM/Hospital das Clínicas, Faculty of Medicine, University of Campinas, Campinas, SP]. PARTICIPANTS: 415 neonates divided into 5 groups: eighty-three infants born from cardiac mothers; 98 from mothers that had toxemia; 54 of the mothers had diabetes mellitus; 40 were HIV positive and 140 had no diseases. INTERVENTION: All newborns had cord blood samples collected on filter paper at birth. MAIN MEASUREMENTS: TSH was measured from dried blood spots using a homemade immunofluorescence assay (sensitivity in dried blood spots = 0.1 mU/L). RESULTS: There was no significant difference in the mean TSH levels among the 5 groups. Moreover, TSH levels were around 5 mU/L in 48% of the newborns, indicating that our region is severely deficient in iodine. CONCLUSIONS: Our results indicate that primary TSH screening programs using cord blood are not affected by maternal diseases. We suggest that, besides its technical advantages over heel punctures with T4 primary approaches, neonatal screening using primary cord blood TSH may also be used as a monitoring tool for evaluation and control of iodine deficiency disorders (IDD).
Acesso aberto (Open Access)
Valor preditivo dos parâmetros clínicos e dos marcadores biofísicos e bioquímicos, no primeiro trimestre gestacional, na detecção de fetos pequenos para a idade gestacional
(Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Antunes, Irene Reali [UNIFESP]; Pares, David Baptista Da Silva [UNIFESP]; Universidade Federal de São Paulo
Objective: To evaluate the predictive values of maternal characteristics, biophysical parameters (mean arterial pressure [MAP] and Doppler uterine artery measurements), and biochemical parameters (pregnancy-associated plasma protein A [PAPP-A] and placental growth factor [PlGF]) alone and in association for small-for-gestational age (SGA) fetuses, in the absence of pre-eclampsia. Methods: We performed a retrospective analysis of a prospective observational study that evaluated 615 pregnant women in the first trimester using ultrasonography. For all the women, information regarding clinical and obstetric histories, MAP, and uterine artery mean pulsatility index (UtA-PI), and blood samples for analysis of biochemical markers (PAPP-A and PlGF) were obtained. The patients were grouped according to birth weight as follows: group I (n = 571), newborns with weights greater than the 10 th percentile (control); group II (n = 44), newborns with weights lower than the 10 th percentile; and group III (n = 34), newborns with weights lower than the fifth percentile. The predictive values of the variables for the detection of small-for-gestational-age fetuses were calculated using a logistic regression model and an analysis of the area under the receiver- operating characteristic curve (AUC). Results: The sensitivity rates of the maternal characteristics, biophysical markers (MAP and UtA-PI), biochemical markers (PAPP-A and PlGF), and the association between them were: 23.3%, 32.5%, 25%, and 30% respectively, at a false-positive (FP) rate of 10%, in group II and 26.5%, 26.5%, 23.5%, and 23.5%, respectively, at a FP rate of 10% in group III. Conclusions: The predictive performances of the combination of maternal characteristics and biophysical and biochemical parameters were unsatisfactory, with a slight improvement in the predictive capacity for SGA fetuses with weights lower than the 10 th percentile.

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