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ABSTRACT Objective: To evaluate the physicians' knowledge regarding the referral for dental screening prior to chemotherapy and radiotherapy. Material and Methods: We conducted a cross-sectional study using simple random sampling among 468 physicians from various specialties with diverse experience levels from different regions in Saudi Arabia. A self-reporting questionnaire was distributed among the physicians, which consisted of questions assessing the physicians' knowledge about oral health and complications in patients prior to chemotherapy and radiotherapy. Statistical analysis was done after the data was collected employing SPSS, and p<0.05 was taken as significant. Results: Residents were more as expected (39.3%), followed by specialists (2.31%). The majority had a practice experience for more than five years (67.8%).The scores for the knowledge assessment showed that 51.3%, nearly half of the participants, had lower scores. The scores were statistically significant (p<0.05). Conclusion: General physicians and specialists should be aware of the dental complications and associated diseases in patients with malignancies and those undergoing chemo and radiotherapy. It is proposed that more awareness should be raised among physicians to rectify this lapse.
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Médicos/ética , Concienciación/ética , Conocimientos, Actitudes y Práctica en Salud , Quimioterapia , Neoplasias/radioterapia , Tamizaje Masivo/instrumentación , Estudios Transversales/métodos , Encuestas y Cuestionarios , Interpretación Estadística de DatosRESUMEN
Applications on electromagnetic waves in the field of biotelemetry have increased in the latest years, being used to prevent, diagnose, and treatment of several diseases. In this context, biotelemetry allows minimally invasive monitoring of the physiologic, improving comfort and patient care and significantly reducing hospital costs. Aiming to assist the mineral bone density classification, through a radio frequency signal (RF), for a later diagnosis of osteoporosis, Osseus was proposed in 2018. This equipment is a combination of the application of techniques and concepts of several areas such as software, electrical, electronic, computational, and biomedical engineering, developed at a low cost, with easy access to the population, and non-invasive. However, when placed on evaluation, potential improvements were identified to increase the stability of Osseus operation. It is proposed the implementation of improvements in the antennas used by Osseus, aiming its miniaturization, improvement in the reception of the RF signal, and better stability of the equipment's operation. Then, two antennas were built, one of which was used as a project for the second, which is an array. The array showed significant improvements in the radiation parameters relevant to the application, being a candidate to replace the antennas currently in use at Osseus.
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Tamizaje Masivo/instrumentación , Osteoporosis/diagnóstico , Telemetría/instrumentación , Dispositivos Electrónicos Vestibles , Ingeniería Biomédica , Densidad Ósea , Campos Electromagnéticos , Diseño de Equipo , Humanos , Tamizaje Masivo/métodos , Miniaturización , Programas Informáticos , Telemetría/métodosRESUMEN
PURPOSE: Obstructive Sleep Apnea (OSA) is related to cardiovascular, metabolic, and neurocognitive diseases. Furthermore, OSA symptoms, such as excessive sleepiness, fatigue, and mood disorders, may interfere in functioning. The assessment of this aspect in patients with OSA is not frequent and no specific instrument is available in the literature. Our aim is to identify if the International Classification of Functioning, Disability and Health (ICF) domains are considered in the validated instruments used to assess patients with OSA. METHODS: In this integrative literature review, three databases were searched: Pubmed, Embase, and LILACS. Bibliographic survey was carried out in 2020, between March and July. Articles published in English, Portuguese, and Spanish with validated tools to assess OSA in adults were included. RESULTS: Thirty instruments have undergone a process of concept extraction and coding according to the ICF, generating a total of 769 significant concepts. It was observed that the function domain was the most prevalent, making 42% (n = 323) of the concepts, followed by domains of activity (16%), participation (10%), environmental factors (5%), personal factor (5%), and structure (1%). Only one instrument, the "Sleep Apnea Quality of Life Index (SAQLI)," encompasses all domains of the ICF in its constructs. CONCLUSION: In the analyzed instruments, the function domain prevails, with most concepts related to sleep functions. Only one validated instrument included in this research covered all the ICF domains. This instrument closely matched the recommended way of assessing functioning, though it approached the domains in an unbalanced way.
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Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud , Tamizaje Masivo/instrumentación , Apnea Obstructiva del Sueño/diagnóstico , HumanosRESUMEN
BACKGROUND: Dimensions of Anger Reactions (DAR-5) is a brief 5-item instrument to assess experience of anger. We aimed to verify the DAR-5 as a screening instrument in the community. METHODS: A sample of 368 apparently healthy adults who attended an outpatient ambulatory facility self-reported on the DAR-5 scale, the Spielberger's State-Trait Anger Expression Inventory (STAXI), the Beck Anxiety Inventory (BAI), and the Patient Health Questionnaire (PHQ-9). Indicators of reliability and validity were calculated to demonstrate the performance of the DAR-5. RESULTS: According to the DAR-5, around half the respondents found themselves becoming angry with people or situations and reported persistent duration of anger. Antagonism towards others was the least frequently experienced anger (8.4%). The DAR-5 was found to be reliable and stable, showing a significant correlation with the BAI and PHQ-9 for both sexes. In confirmatory factor analysis, a one-dimensional structure of anger experience was demonstrated through salient fit statistics. A cut-off > 8 was the best threshold against STAXI for discriminating cases of anger, irrespective of sex. CONCLUSIONS: The shortness of the DAR-5, along with its cost-effective applicability, qualifies this measuring tool as a useful instrument for inclusion in the routine assessment of anger reactions in the general population.Key pointsThis is the first time the validity of DAR-5 has been demonstrated in a developing country.The Portuguese version of DAR-5 has appropriate sensitivity and high specificity.The DAR-5 demonstrated to be a reliable and stable instrument, irrespective of sex.
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Ira , Tamizaje Masivo , Encuestas y Cuestionarios , Humanos , Tamizaje Masivo/instrumentación , Reproducibilidad de los ResultadosRESUMEN
La tecnología digital móvil (mSalud), recurso aún subutilizado, tiene el potencial para transformarse en un auxiliar imprescindible en la práctica clínica, en particular en Cardiología. La fibrilación auricular es la arritmia más frecuente, cuya prevalencia aumenta con la edad y tiene como complicación más temida el accidente cerebrovascular. Su prevención depende de un diagnóstico oportuno, una adecuada estratificación de riesgo y el uso de anticoagulantes orales. Sin embargo, es con frecuencia paroxística y asintomática, lo que dificulta su diagnóstico. El aporte de la tecnología mediante el desarrollo de aplicaciones para celulares, relojes, dispositivos portátiles o implantables que registran el ritmo cardíaco y permiten el monitoreo prolongado, ambulatorio y a distancia facilitan su detección. Se repasan las principales evidencias que justifican la aplicación de estas estrategias de tamizaje, cuando está indicado realizarlo, cómo y a quiénes hacerlo. Por último, se plantea también la utilidad de estas estrategias de monitoreo prolongado en el manejo y la prevención de la fibrilación auricular.
The mobile digital technology (mHealth), a tool still underutilized, has the potential to become an essential aid in clinical practice, particularly in Cardiology. Atrial fibrillation is the most frequent arrhythmia whose prevalence increases with age and its most feared complication is cerebrovascular accident. Its prevention depends on a timely diagnosis, an adequate risk stratification and the use of oral anticoagulants. However, it is frequently paroxysmal and asymptomatic, which makes its diagnosis difficult. The contribution of technology through the development of applications for cell phones, watches, portable or implantable devices that record the heart rhythm and allow prolonged, outpatient and remote monitoring, facilitate its detection. The main evidences that justify the application of these screening strategies are reviewed, when it is indicated to perform it, how and to whom to do it. Finally, the usefulness of these prolonged monitoring strategies in the management and prevention of atrial fibrillation is also considered.
A utilização da tecnologia digital móvel (m-Saúde), ainda pouco utilizada, tem potencial para se tornar um auxílio essencial na prática clínica, principalmente na Cardiologia. A fibrilação atrial é a arritmia mais frequente, cuja prevalência aumenta com a idade e sua complicação mais temida é o acidente vascular cerebral. Sua prevenção depende de um diagnóstico oportuno, de uma estratificação de risco adequada e do uso de anticoagulantes orais. Porém, freqüentemente é paroxística e assintomática, o que dificulta seu diagnóstico. A contribuição da tecnologia por meio do desenvolvimento de aplicativos para telefones celulares, relógios, dispositivos portáteis ou implantáveis ââque registram o ritmo cardíaco e permitem monitoramento prolongado, ambulatorial e remoto, facilitam sua detecção. São revisadas as principais evidências que justificam a aplicação dessas estratégias de rastreamento, quando é indicado fazê-lo, como e para quem fazê-lo. Finalmente, a utilidade dessas estratégias de monitoramento prolongado no manejo e prevenção da fibrilação atrial também é considerada.
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Humanos , Fibrilación Atrial/diagnóstico , Tamizaje Masivo/instrumentación , Telemedicina/instrumentación , Fibrilación Atrial/prevención & control , Telemedicina/estadística & datos numéricos , Accidente Cerebrovascular/prevención & control , Estrategias de eSaludRESUMEN
ABSTRACT Purpose: to develop a screening instrument to identify the risk of developmental stuttering in preschoolers. Methods: the procedures were divided into two stages: The first one (theoretical), consisted of the literature review and the construction of the items that make up the instrument; the second stage (content validation), consisted of the analysis of the instrument by a judging committee formed by 10 speech-language-hearing therapists who work in the field of fluency. The data analysis was based on the calculation of the item content validity index (I-CVI) and the total number of answers (T-CVI). Also, an item reliability analysis was conducted with Cronbach's alpha. Results: the Developmental Stuttering Screening Instrument (DSSI) encompassed 24 items distributed into four key categories. The I-CVI and T-CVI revealed a high agreement between the judges. The Cronbach's alpha coefficients indicated a high internal consistency between the judges' answers in 19 of the 24 items. The qualitative analysis pointed to the need for new adjustments. All the analyses contributed to the construction of the second version of the instrument. Conclusion: the proposed instrument showed content-based validity evidence that made it possible, up to the present moment, to adjust it to its construct. It is suggested that the validation process continue, employing new accuracy measures.
RESUMO Objetivo: elaborar um instrumento de rastreio com fins de identificação do risco para gagueira do desenvolvimento em crianças pré-escolares. Métodos: os procedimentos foram divididos em duas etapas: A primeira etapa - teórica, consistiu na revisão da literatura e a construção dos itens que compõe o instrumento; A segunda etapa - validação de conteúdo, consistiu da análise do instrumento por um comitê de juízes composto por 10 fonoaudiólogas atuantes na área da Fluência. Para análise dos dados foi calculado o índice de validade de conteúdo por item (IVC-I) e pelo total de respostas (IVC-T), bem como realizada uma análise da confiabilidade dos itens por meio do alfa de Cronbach. Resultados: o Instrumento de Rastreio para a Gagueira do Desenvolvimento (IRGD) foi composto por 24 itens distribuídos em quatro categorias-chaves. Os índices IVC-I e IVC-T evidenciaram alta concordância entre os juízes. Os coeficientes do alfa de Cronbach indicaram alta consistência interna entre as respostas dos juízes em 19 dos 24 itens. A análise qualitativa destacou a necessidade de novos ajustes. Todas as análises possibilitaram a construção da segunda versão do instrumento. Conclusão: o instrumento proposto mostrou evidências de validade baseada no conteúdo que permitiram, até o momento, ajustá-lo em relação ao seu construto. Sugere-se a continuidade do processo de validação por meio do emprego de novas medidas de acurácia.
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Humanos , Preescolar , Tartamudeo/diagnóstico , Tamizaje Masivo/instrumentación , Factores de RiesgoRESUMEN
We sought to develop a smooth and low cost sample preparation and DNA extraction protocol, streamlined with a ready-to-use qPCR in a portable instrument to overcome some of the existing hurdles. Several solutions were evaluated as to their ability to liquefy a mucin-based matrix. Each liquefied matrix, supplemented with either Mycobacterium tuberculosis (MTB) H37Rv strain DNA or intact cells, was aliquoted onto a filter paper embedded with solubilizing agents, and was subsequently dried up. Most of the nucleic acids, including genomic DNA from the bacilli and the host, binds to the filter paper. Next, several protocols were evaluated to elute the DNA from the paper, using qPCR to detect the insertion sequence IS6110, a M. tuberculosis complex genomic marker. The limit of detection (LOD) of the best protocol was then evaluated using parallel seeding and colony counting. The protocol was also evaluated using seventeen sputum samples, previously characterized by the GeneXpert or culture. Two instruments (the ABI7500 Standard and the Q3-Plus system) and two reagents storage formats (frozen or ready-to-use) were evaluated. Solutions containing guanidine isothiocyanate exerted the best liquefying effect on the mucin-based matrix extracted from one 6-mm punches, followed by a brief incubation at 95°C. The resulting DNA contained impurities, but a simple 1:10 dilution elicited the detection of MTB and human genomic targets. The described protocol presented an apparent LOD of 02 CFU/mL of MTB. Challenging the protocol with previously characterized samples showed substantial agreement with GeneXpert MTB/RIF results (sensitivity of 90%, agreement of 88.9%, kappa coefficient of 0.77), and moderate agreement with culture results (sensitivity of 100%, agreement of 78.9%, kappa coefficient of 0.58). This work presents a sensitive proof-of-concept protocol for sputum liquefaction and decontamination followed by a simple DNA extraction procedure, in which the extraction steps are streamlined with a ready-to-use qPCR in a portable instrument that can be employed in low infrastructure settings.
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Tamizaje Masivo/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Sistemas de Atención de Punto , Manejo de Especímenes/métodos , Tuberculosis Pulmonar/diagnóstico , Brasil , ADN Bacteriano/aislamiento & purificación , Humanos , Límite de Detección , Tamizaje Masivo/economía , Tamizaje Masivo/instrumentación , Mycobacterium tuberculosis/genética , Prueba de Estudio Conceptual , Reacción en Cadena en Tiempo Real de la Polimerasa/economía , Reacción en Cadena en Tiempo Real de la Polimerasa/instrumentación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Manejo de Especímenes/economía , Esputo/microbiología , Tuberculosis Pulmonar/microbiologíaRESUMEN
OBJECTIVE: To compare the Edmonton Frail Scale (EFS) and Clinical-Functional Vulnerability Index-20 (CFVI-20) instruments regarding degree of agreement and correlation and compare descriptive models with frailty-associated variables in community-dwelling older people in Brazil. METHODS: Cross-sectional study, nested in a population-based and household cohort. Baseline sampling was calculated based on a probabilistic approach by conglomerate in two stages. In the first stage, census tract was used as sampling unit. In the second, the number of households was defined according to the population density of individuals aged ≥ 60 years. The Kappa statistic evaluated the agreement between instruments and Pearson's coefficient their correlation. Factors associated with frailty and high risk of clinical-functional vulnerability were identified by multiple analysis of Poisson regression with robust variance. RESULTS: Kappa statistics was 0.599 and Pearson's correlation coefficient 0.755 (p < 0.001). The EFS found a 28.2% prevalence of frailty, and the CFVI-20 found a 19.5% prevalence of high risk of clinical-functional vulnerability. Age equal to or greater than 80 years, history of stroke, polypharmacy, negative self-perceived health, fall in the past 12 months, and hospitalization in the past 12 months were variables associated with frailty in both instruments after multiple analysis. Less than four years of education, osteoarticular disease, and weight loss were associated with frailty only by EFS, and having a caregiver was associated with a high risk of clinical-functional vulnerability only by CFVI-20. CONCLUSIONS: Although the analyses show moderate agreement and strong positive correlation between the instruments, the indicated prevalence of frailty is discrepant. Our results attest the need to standardize the instrument for assessing frailty in community-dwelling older people.
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Anciano Frágil , Fragilidad , Vida Independiente , Tamizaje Masivo , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Fragilidad/diagnóstico , Fragilidad/epidemiología , Humanos , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Malaria can be transmitted by blood transfusion through donations collected from asymptomatic donors. Transfusion-transmitted malaria (TTM) poses a great risk to blood services worldwide. A good screening tool for Plasmodium spp. detection in blood banks must have a high sensitivity for prevention of TTM. However, in Brazilian blood banks, screening for malaria still relies on microscopy. METHODS: In Brazil, screening for human immunodeficiency virus type 1 (HIV), RNA/DNA for hepatitis C (HCV) and hepatitis B (HBV) viruses is mandatory for every blood donation and uses nucleic acid amplification testing (NAT). The aim of this study was to evaluate the inclusion of an assay for malaria to identify Plasmodium sp. from total nucleic acid (TNA; DNA/RNA) by targeting the 18S rRNA gene of the parasite. RESULTS: Considering the limitations of microscopy and the wide availability of the Brazilian NAT platform in the screening of blood units for HIV, HCV, and HBV, a molecular diagnostic tool was validated for detection of Plasmodium sp. in blood banks; a pilot study showed that using this novel NAT assay could reduce the risk of TTM. CONCLUSION: The prototype HIV/HCV/HBV/malaria NAT assay was effective in detecting infected candidate donors and has good prospects to be applied in routine screening for preventing TTM.
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Malaria/prevención & control , Tamizaje Masivo/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Plasmodium/aislamiento & purificación , Vigilancia de la Población/métodos , Adolescente , Adulto , Bancos de Sangre , Transfusión Sanguínea , Brasil , Monitoreo Epidemiológico , Femenino , Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Humanos , Malaria/transmisión , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Proyectos Piloto , Plasmodium/genética , ARN Protozoario/análisis , ARN Ribosómico 18S/análisis , Adulto JovenRESUMEN
AIMS: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. METHODS: This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. RESULTS: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. CONCLUSIONS: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. Daily rate of patients whose examinations allowed clinical decision. X-axis: day of examination; Y-axis: rate (%) of patients whose examinations allowed a clinical decision.
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Retinopatía Diabética/diagnóstico , Tamizaje Masivo/métodos , Fotograbar/métodos , Retina/diagnóstico por imagen , Telemedicina/métodos , Adulto , Anciano , Brasil , COVID-19 , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Retinopatía Diabética/diagnóstico por imagen , Femenino , Humanos , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Atención Primaria de Salud/métodos , Estudios Prospectivos , Derivación y Consulta , Teléfono Inteligente , Telemedicina/instrumentaciónRESUMEN
OBJECTIVE: To develop and validate a brief screening instrument for postpartum depression in resource-constrained primary care settings. METHOD: Secondary data analysis of a cohort of 305 mothers (Mdnage = 26) attending well-child check-ups in six primary care centers in Santiago, Chile, answered the Edinburgh Postnatal Depression Scale (EPDS), the 36-Item Short Form Health Survey, and the Mini International Neuropsychiatric Interview depression module. A predictive model for postpartum depression was built using logistic and least absolute shrinkage and selection operator regressions, with bootstrap validation. RESULTS: A three-item version of the EPDS exhibited excellent discriminative capacity (c statistic = 0.95) and showed no significant differences versus the full version of the EPDS (χ2 (1) = 1.75, p = .187). The best trade-off between sensitivity (92.86%) and specificity (86.70%) was achieved at a cut-off score of 8/9. CONCLUSIONS: The three-item version of the EPDS can save clinicians valuable time, which might potentially improve communication of results to patients.
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Depresión Posparto/diagnóstico , Tamizaje Masivo/instrumentación , Madres/psicología , Escalas de Valoración Psiquiátrica , Adulto , Chile , Femenino , Humanos , Madres/estadística & datos numéricos , Atención Primaria de Salud , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). METHODS: The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. RESULTS: The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. CONCLUSION: The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.
OBJETIVO: Este estudo visou validar o Protocolo de Avaliação Miofuncional Orofacial MBGR para adultos com DTM. MÉTODO: Participaram 30 adultos, sendo 15 com DTM (deslocamento de disco com redução segundo o Research Diagnostic Criteria for Temporomandibular Disorders) e 15 Controles. O processo de validação envolveu a validade de conteúdo, de critério e de construto, além da concordância inter e intra-avaliador, sensibilidade e especificidade. Considerou-se nível de significância de 5%. RESULTADOS: Foram confirmadas as validades de conteúdo, visto que o Protocolo MBGR abarca todas as questões funcionais presentes em indivíduos com DTM; de critério, com correlações significantes entre o MBGR e AMIOFE; e de construto, diferenciando indivíduos com e sem DMO quanto à dor à palpação e mobilidade mandibular, com correlação significante entre a avaliação clínica do MBGR e o uso do algômetro digital, bem como confirmação do exame instrumental para a classificação do modo respiratório. A força de concordância variou de pobre a muito boa para a análise interavaliador e de razoável a muito boa para intra-avaliador. Os valores de sensibilidade e especificidade foram elevados. CONCLUSÃO: O Protocolo MBGR mostrou-se válido para aplicação em adultos com DTM com deslocamento de disco com redução e controles, contemplando todos os aspectos que possibilitam a análise das condições oromiofuncionais nesses indivíduos.
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Trastornos de Deglución/diagnóstico , Músculos Faciales/fisiopatología , Mandíbula/fisiopatología , Tamizaje Masivo/instrumentación , Trastornos de la Articulación Temporomandibular/diagnóstico , Adolescente , Adulto , Estudios de Casos y Controles , Trastornos de Deglución/fisiopatología , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/fisiopatología , Dimensión del Dolor , Sensibilidad y Especificidad , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the utility of universal psychosocial screening in the emergency department (ED) using MyHEARTSMAP, a digital self-assessment and management guiding tool. STUDY DESIGN: We conducted a cohort study of youth 10-17 years of age with nonmental health related presentations at 2 pediatric EDs. On randomly selected shifts (December 2017-February 2019), participants completed their psychosocial self-assessments using MyHEARTSMAP on a mobile device, then underwent a standardized clinical mental health assessment (criterion standard). We reported the sensitivity and specificity of respondents' self-assessment, against a clinician's standard emergency psychosocial assessment, and the frequency of psychosocial issues and recommended mental health resources identified by screening. RESULTS: We approached 1432 eligible youth, among which 795 youth consented to participate (55.5%). Youth and guardians' sensitivity at self-identifying psychiatric concerns was 92.7% (95% CI 89.1, 95.4%) and 93.1% (95% CI 89.5, 95.8%), respectively. In cases where clinicians had determined to be no psychiatric issues, 98.5% (95% CI 96.7, 99.4%) of youth and 98.9% (95% CI 97.3, 99.7%) of guardians identified the youth as having no or only mild issues. Screening identified 36.4% of youth as having issues in at least 1 psychosocial domain which warranted further follow-up. CONCLUSIONS: Psychosocial screening in EDs using MyHEARTSMAP can reliably be conducted using the MyHEARTSMAP self-assessment tool and over one-third of screened youth identified issues which can be directed to further care.
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Tamizaje Masivo/instrumentación , Trastornos Mentales/diagnóstico , Autoevaluación (Psicología) , Adolescente , Niño , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
RESUMO Objetivo Este estudo visou validar o Protocolo de Avaliação Miofuncional Orofacial MBGR para adultos com DTM. Método Participaram 30 adultos, sendo 15 com DTM (deslocamento de disco com redução segundo o Research Diagnostic Criteria for Temporomandibular Disorders) e 15 Controles. O processo de validação envolveu a validade de conteúdo, de critério e de construto, além da concordância inter e intra-avaliador, sensibilidade e especificidade. Considerou-se nível de significância de 5%. Resultados Foram confirmadas as validades de conteúdo, visto que o Protocolo MBGR abarca todas as questões funcionais presentes em indivíduos com DTM; de critério, com correlações significantes entre o MBGR e AMIOFE; e de construto, diferenciando indivíduos com e sem DMO quanto à dor à palpação e mobilidade mandibular, com correlação significante entre a avaliação clínica do MBGR e o uso do algômetro digital, bem como confirmação do exame instrumental para a classificação do modo respiratório. A força de concordância variou de pobre a muito boa para a análise interavaliador e de razoável a muito boa para intra-avaliador. Os valores de sensibilidade e especificidade foram elevados. Conclusão O Protocolo MBGR mostrou-se válido para aplicação em adultos com DTM com deslocamento de disco com redução e controles, contemplando todos os aspectos que possibilitam a análise das condições oromiofuncionais nesses indivíduos.
ABSTRACT Purpose This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). Methods The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. Results The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. Conclusion The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Trastornos de Deglución/diagnóstico , Trastornos de la Articulación Temporomandibular/diagnóstico , Tamizaje Masivo/instrumentación , Músculos Faciales/fisiopatología , Mandíbula/fisiopatología , Dimensión del Dolor , Trastornos de Deglución/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Estudios de Casos y Controles , Tamizaje Masivo/estadística & datos numéricos , Sensibilidad y Especificidad , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/fisiopatologíaRESUMEN
ABSTRACT The development of tracking technology caused a exponentially grow-up of research into this topic. The use of standardized methodologies is useful to contrast data of different studies. On the other hand, a low-cost reference system is needed. For this reason, the main aim of the present research is the description of a specific protocol to accuracy assessment of tracking location in indoor conditions in basketball. It can resume in three steps with detailed and easily procedures in the method section. The accuracy analysis method presented can report the centimeter of accuracy in each coordinate that the tracking system measure. A standardized protocol to evaluate the location on indoor conditions in basketball will provide to the sport science professionals a useful tool to analyze the accuracy and reliability of all tracking system, being the results can compare both within and between-court.
RESUMO O desenvolvimento da tecnologia de rastreamento causou um crescimento exponencial das pesquisas sobre esse tópico. O uso de metodologias padronizadas é útil para contrastar dados de diferentes estudos. Por outro lado, é necessário um sistema de referência de baixo custo. Por este motivo, o principal objetivo da presente pesquisa é a descrição de um protocolo específico para avaliação da acurácia do rastreamento de localização em condições internas no basquete. Pode retomar em três etapas com procedimentos detalhados e fáceis na seção do método. O método de análise de precisão apresentado pode relatar o centímetro de precisão em cada coordenada medida pelo sistema de rastreamento. Um protocolo padronizado para avaliar a localização em condições internas no basquetebol fornecerá aos profissionais de ciências do esporte uma ferramenta útil para analisar a precisão e a confiabilidade de todo o sistema de rastreamento, sendo que os resultados podem ser comparados dentro e entre as quadras.
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Baloncesto/estadística & datos numéricos , Desarrollo Tecnológico/estadística & datos numéricos , Tamizaje Masivo/instrumentación , Deportes/estadística & datos numéricos , Medicina Deportiva/instrumentación , Tecnología/tendencias , Ergometría/estadística & datos numéricos , Costos y Análisis de Costo/estadística & datos numéricos , /análisisRESUMEN
ABSTRACT OBJECTIVE: To compare the Edmonton Frail Scale (EFS) and Clinical-Functional Vulnerability Index-20 (CFVI-20) instruments regarding degree of agreement and correlation and compare descriptive models with frailty-associated variables in community-dwelling older people in Brazil. METHODS: Cross-sectional study, nested in a population-based and household cohort. Baseline sampling was calculated based on a probabilistic approach by conglomerate in two stages. In the first stage, census tract was used as sampling unit. In the second, the number of households was defined according to the population density of individuals aged ≥ 60 years. The Kappa statistic evaluated the agreement between instruments and Pearson's coefficient their correlation. Factors associated with frailty and high risk of clinical-functional vulnerability were identified by multiple analysis of Poisson regression with robust variance. RESULTS: Kappa statistics was 0.599 and Pearson's correlation coefficient 0.755 (p < 0.001). The EFS found a 28.2% prevalence of frailty, and the CFVI-20 found a 19.5% prevalence of high risk of clinical-functional vulnerability. Age equal to or greater than 80 years, history of stroke, polypharmacy, negative self-perceived health, fall in the past 12 months, and hospitalization in the past 12 months were variables associated with frailty in both instruments after multiple analysis. Less than four years of education, osteoarticular disease, and weight loss were associated with frailty only by EFS, and having a caregiver was associated with a high risk of clinical-functional vulnerability only by CFVI-20. CONCLUSIONS: Although the analyses show moderate agreement and strong positive correlation between the instruments, the indicated prevalence of frailty is discrepant. Our results attest the need to standardize the instrument for assessing frailty in community-dwelling older people.
RESUMO OBJETIVO: Comparar os instrumentos Edmonton Frail Scale (EFS) e Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) quanto ao grau de concordância e de correlação, bem como comparar modelos descritivos com variáveis associadas à fragilidade em idosos brasileiros comunitários. MÉTODOS: Estudo transversal, aninhado a uma coorte de base populacional e domiciliar. A amostragem na linha de base foi probabilística, por conglomerados, em dois estágios. No primeiro, utilizou-se como unidade amostral o setor censitário. No segundo, definiu-se o número de domicílios segundo a densidade populacional de indivíduos com idade ≥ a 60 anos. A estatística Kappa analisou a concordância, e o coeficiente de Pearson avaliou a correlação entre os instrumentos. Os fatores associados à fragilidade e ao alto risco de vulnerabilidade clínico-funcional foram identificados por análise múltipla de regressão de Poisson com variância robusta. RESULTADOS: A estatística Kappa foi 0,599, e o coeficiente de correlação de Pearson foi de 0,755 (p < 0,001). A prevalência da fragilidade foi de 28,2% pela EFS, e a prevalência do alto risco de vulnerabilidade clínico-funcional foi de 19,5% pelo IVCF-20. As variáveis associadas à fragilidade, após análise múltipla, em ambos os instrumentos, foram: idade igual ou superior a 80 anos, histórico de acidente vascular encefálico, polifarmácia, autopercepção negativa de saúde, queda nos últimos 12 meses e internação nos últimos 12 meses. Escolaridade inferior a quatro anos, doença osteoarticular e perda de peso foram associadas a fragilidade apenas pela EFS, enquanto possuir cuidador esteve associado a alto risco de vulnerabilidade clínico-funcional somente pelo IVCF-20. CONCLUSÕES: Embora as análises revelem concordância moderada e forte correlação positiva entre os instrumentos, a prevalência de fragilidade apontada é discrepante. O resultado destaca a necessidade de padronizar o instrumento para aferir a fragilidade em idosos comunitários.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Tamizaje Masivo/instrumentación , Anciano Frágil , Vida Independiente , Fragilidad/diagnóstico , Fragilidad/epidemiología , Brasil/epidemiología , Prevalencia , Estudios Transversales , Reproducibilidad de los Resultados , Persona de Mediana EdadAsunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Próstata/diagnóstico , Tamizaje Masivo/efectos adversos , Antígeno Prostático Específico/análisis , Toma de Decisiones , Relaciones Médico-Paciente , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/prevención & control , Neoplasias de la Próstata/terapia , Literatura de Revisión como Asunto , Tamizaje Masivo/instrumentación , Tamizaje Masivo/tendencias , Tamizaje Masivo/estadística & datos numéricos , Metaanálisis como AsuntoRESUMEN
Background and Objectives: To verify the use of the tri-ponderalmass index (TMI) as a screening tool for risk of central fat accumulation in preschool children. Materials and Methods: An observational, analytical study was carried out on samples from children 2 to 5 years of age. The body mass index (BMI) and the tri-ponderalmass index (TMI: Weight/height3) were calculated. The waist circumference-to-height ratio (WHtR) was used to classify central fat accumulation risk. Preschoolers whose WHtRwas in the upper tertile of the sample were classified as at risk for central fat accumulation. A comparison of the two indicators (BMI and TMI) was made from the area under the receiver operator characteristics (ROC) curve (AUC) in the discrimination of the WHtR. Results: The sample used for analysis was 919 preschoolers. The mean age of the children was 3.9 years (SD = 0.7). The difference in AUC was 5% higher for TMI (p < 0.0001). In the individual analysis of the ROC curve of the TMI, favoring a higher sensitivity, the cutoff point of 14.0 kg/m3 showed a sensitivity of 99.3% (95% CI: 97.6-99.9). Conclusion: Considering WHtR as a marker of possible future metabolic risk among preschool children, TMI proved to be a useful tool, superior to BMI, in screening for risk of central fat accumulation in preschool children.
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Producto de la Acumulación de Lípidos , Tamizaje Masivo/métodos , Medición de Riesgo/normas , Área Bajo la Curva , Índice de Masa Corporal , Brasil , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo/instrumentación , Tamizaje Masivo/normas , Curva ROC , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de RiesgoRESUMEN
RESUMEN Objetivo Dada la ausencia evidente de validaciones que repliquen la estructura interna del Inventario de Salud Mental - 5 (MHI-5) en adolescentes peruanos, el presente estudio realiza una evaluación preliminar de las propiedades psicométricas del MHI-5, específicamente de su estructura interna. Métodos La muestra fue de 75 estudiantes de ambos sexos de una institución educativa privada de nivel secundario del distrito de Casma (Lima, Perú). El análisis se realizó mediante la aplicación de un enfoque confirmatorio de análisis factorial dentro el modelamiento de ecuaciones estructurales. Resultados Se obtuvo que una sola dimensión significativa es viable para interpretar sus puntajes, pero el ajuste mejoró sustancialmente cuando de introdujo un factor que representó el efecto del fraseo negativo de dos ítems. Por otro lado, la consistencia interna fue mayor a 0,70, considerada como satisfactoria dada su brevedad. Conclusiones Se concluye que el MHI-5 mantiene la unidimensionalidad esencial, pero se requiere introducir el posible efecto del método debido al contenido de alguno de sus ítems. La confiabilidad de consistencia fue aceptable para propósitos de tamizaje. Se discuten los siguientes pasos para acumular más evidencias de validez, sugiriéndose desarrollar una versión más abreviada sin los ítems problemáticos, para reducir el potencial sesgo de respuesta.(AU)
ABSTRACT Objective Given the evidence missing from validity studies that replicate the internal structure of the Mental Health Inventory - 5 (MHI-5) in Peruvian adolescents, this study performs a preliminary evaluation of the psychometric properties of MHI-5, specifically its internal structure. Methods The sample was 75 students of both sexes from a private high school-level educational institution, in the Casma city (Lima, Peru). The analysis was performed by applying a confirmatory factor analysis approach within the modeling of structural equations. Results A single significant dimension was found to be viable for interpreting the scores, but the fit was substantially improved when a factor was introduced that represented the effect of two item negative phrasing. On the other hand, the internal consistency was greater than .70, and it is considered satisfactory given its brevity. Conclusions It is concluded that the MHI-5 maintains the essential one-dimensionality, but it is required to introduce the possible effect of the method due to the content of some of its items. Consistency reliability was acceptable for screening purposes. The following steps are discussed to accumulate more validity evidence, suggesting to develop a shorter version without the problematic items, to reduce the potential response bias.(AU)
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Humanos , Adolescente , Salud del Adolescente , Trastornos Mentales/diagnóstico , Perú/epidemiología , Sesgo , Tamizaje Masivo/instrumentación , Estudios Transversales/instrumentaciónRESUMEN
Nearly 90% of cervical cancer cases and deaths occur in low- and middle-income countries that lack comprehensive national HPV immunization and cervical cancer screening programs. In these settings, it is difficult to implement screening programs due to a lack of infrastructure and shortage of trained personnel. Screening programs based on visual inspection with acetic acid (VIA) have been successfully implemented in some low-resource settings. However, VIA has poor specificity and up to 90% of patients receiving treatment based on a positive VIA exam are over-treated. A number of studies have suggested that high-resolution cervical imaging to visualize nuclear morphology in vivo can improve specificity by better distinguishing precancerous and benign lesions. To enable high-resolution imaging in low-resource settings, we developed a portable, low-cost, high-resolution microendoscope that uses a mobile phone to detect and display images of cervical epithelium in vivo with subcellular resolution. The device was fabricated for less than $2,000 using commercially available optical components including filters, an LED and triplet lenses assembled in a 3D-printed opto-mechanical mount. We show that the mobile high-resolution microendoscope achieves similar resolution and signal-to-background ratio as previously reported high-resolution microendoscope systems using traditional cameras and computers to detect and display images. Finally, we demonstrate the ability of the mobile high-resolution microendoscope to image normal and precancerous squamous epithelium of the cervix in vivo in a gynecological referral clinic in Barretos, Brazil.