Diagnóstico audiológico de lactentes após falha na triagem auditiva neonatal universal / Hearing assessment after referral in universal newborn hearing screening

RESUMO Objetivo Estudar o processo de diagnóstico audiológico de lactentes que falharam na Triagem Auditiva Neonatal Universal (TANU). Métodos Análise dos prontuários de 51 lactentes que falharam na TANU nas maternidades do munícipio e que foram encaminhados a um centro de referência em saúde auditiva para diagnóstico audiológico, entre janeiro e junho de 2021. Foram identificados os lactentes que finalizaram o diagnóstico, aqueles que não compareceram ao agendamento para exames ou evadiram durante o processo. Tentativas de contato foram realizadas com os responsáveis pelos lactentes que evadiram, para identificar o motivo da evasão. Resultados O comparecimento ao diagnóstico ficou em 75%, com evasões entre o encaminhamento da maternidade para o centro de referência, bem como durante o processo de diagnóstico. Cinquenta por cento dos sujeitos concluíram as avaliações audiológicas até os 3 meses de vida. A tentativa de contato foi bem-sucedida com os responsáveis pelos lactentes que evadiram, sendo os motivos mais frequentes: adoecimento do lactente, distância entre a moradia e o centro de referência, horário de trabalho dos pais. Conclusão Na etapa de diagnóstico, o índice de comparecimento e o tempo de conclusão até o terceiro mês de vida da criança ficaram abaixo dos índices recomendados, diminuindo a efetividade do Programa de Triagem Auditiva Neonatal Universal (PTANU). A busca ativa por contato telefônico e uso de aplicativo de mensagem telefônico foi importante para reduzir a evasão em 76%. Outras ferramentas que aprimorem o processo para um diagnóstico não prolongado, evitando evasões, necessitam ser estudadas.

ABSTRACT Purpose To study the process of hearing assessment in infants who were referred by professionals responsible for Universal Newborn Hearing Screening (UNHS). Methods Analysis of the medical records of 51 infants referred by maternity hospitals where UNHS was performed and were referred to a Hearing Health Center, between January and June 2021. Infants who completed hearing assessment, who never attended the appointments, or were lost during the diagnostic process were identified. Attempts were made to contact infants' guardians in order to understand the reason for missing the appointments. Results The attendance to the diagnosis was 75%. Fifty percent of the infants completed hearing assessment as recommended, up to 3 months of life. The attempt to contact parents who missed the appointments was successful, and the most frequent reasons are: the infant was ill on the day of scheduled appointment, distance from home to the hearing health center, parents' working hours. Conclusion For the diagnostic stage, the attendance rate and the age for completing hearing assessment were below the recommended. The active search for telephone contact and use of phone messaging application was important to reduce evasion by seventy-six percent. Tools that optimize the diagnostic process with less infants missing still must be studied.

Adolescent Female Victims of Sexual Violence: Analysis of Loss of Follow-up after Emergency Care and Outpatient Follow-up / Meninas adolescentes vítimas de violência sexual: Análise da falta de atendimento de emergência e seguimento ambulatorial

Abstract Objective To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. Methods This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. Results A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. Conclusion Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.

Resumo Objetivos Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. Métodos Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. Resultados Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,49-14,20]; não ter religião [RP = 2,38 (IC 95%;1,29-4,38)], ter religião católica [RP = 2,11 (IC 95%; 1,17-3,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,25-3,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,36-5,46]) ou apoio social (RP = 2,33 [IC 95%; 1,09-4,99]) foram as variáveis associadas à perda do seguimento ambulatorial. Conclusão Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil / Preditores maternos e infantis associados a perda de seguimento do programa triagem auditiva neonatal: estudo de coorte em maternidades do nordeste do Brasil

ABSTRACT Purpose Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. Methods Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. Results The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. Conclusion The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

RESUMO Objetivo Analisar preditores maternos e infantis associados a perda de seguimento do programa de triagem auditiva neonatal em maternidades em maternidades do nordeste do Brasil. Método Estudo de coorte retrospectivo, incluindo dados secundários de lactentes (n=604) que foram encaminhados para o monitoramento e/ou diagnóstico do programa de triagem auditiva neonatal, em duas maternidades do nordeste do Brasil. Preditores avaliados incluíram fatores socioeconômicos, como, idade materna, estado civil, renda, escolaridade, local de residência, número de filhos e número de pré-natais; E fatores de saúde materno e infantil, como, fumo e drogas durante a gestação, consanguinidade, infecções congênitas, malformações craniofaciais, uso de drogas ototóxicas, síndromes e história de perda auditiva na família. Foi realizado análise estatística baseada em modelos de regressão logística binária, método stepwise. Resultados O modelo de regressão logística contendo o número de pré-natais e a história de perda auditiva na família foi significativo [χ2(2) =34,271; p<0,001]. Foram preditores significativos, o número de pré-natais (OR = 2,343; IC 95%= 1,626 - 3,376) e a história de perda auditiva na família (OR =2,167; IC 95% = 1,507 - 3,115), os demais preditores, não apresentaram significância neste estudo. Conclusão Os resultados demonstram que estão associados e aumentam as chances de perda de seguimento do programa, recém-nascidos cuja mães realizaram ≤ 5 pré-natais com 2,3 vezes mais chances e história de perda auditiva na família aumentando os riscos em 2,1 vezes a mais. É importante fornecer subsídios para que sejam implementadas melhorias na saúde pública que visem aconselhar, orientar e conscientizar as mães, principalmente durante os pré-natais.

Application of mobile phone technology as intervention for the management of tuberculosis patients diagnosed through community survey

Background & objectives: The delay in communicating the results to tuberculosis (TB) patients leads to increased rates of initial loss to follow up of treatment. The gap in communication among healthcare providers requires application of new tools that will address the challenges. Mobile phone technologies could be a useful tool in this context for the delivery of information. The objective was thus to evaluate communication by mobile applications such as the WhatsApp Messenger to decrease initial loss to follow up after initial treatment for TB. Methods: Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India undertook a community prevalence survey to find the burden of TB. During this survey, mobile phone-based technology (WhatsApp messenger) was employed as an intervention among the healthcare providers and researchers involved for communicating. This was further evaluated for its usefulness by examining the initial loss to follow up and patients initiated on treatment. Results: The study covered four blocks of Thiruvallur district of Tamil Nadu, South India, namely Kadambathur, Poondi, Thiruvalangadu and Periyapalayam. The survey population was around 20,000 from each block, and the average patients diagnosed by community TB prevalence survey were 30 patients from each block. Among the patients diagnosed through this survey, in the first block, only 55 per cent were initiated on treatment; subsequently, with the intervention, the initial loss to follow up was significantly reduced from 45 to zero per cent. Interpretation & conclusions: After integrating of WhatsApp messenger application for communication among healthcare providers and research

Régimen corto de tratamiento de tuberculosis farmacorresistente: hacia una menor pérdida del seguimiento de pacientes / Short drug-resistant tuberculosis treatment regimen: towards less loss to follow-up of patients

Los diversos fármacos para luchar contra el complejo Mycobacterium tuberculosis, causante de la tuberculosis, han sido utilizados por varias décadas, resultando de manera colateral en la mutación de cepas resistentes a uno o más de esos medicamentos. La tuberculosis multirresistente, identificada como TB-MDR, es una forma de tuberculosis causada por bacterias que no responden a la isoniazida y la rifampicina, los fármacos de primera línea más eficaces. La Organización Mundial de la Salud (OMS) describe dos esquemas de tratamiento con medicamentos de segunda línea para estos pacientes: el tradicional esquema alargado, y el más reciente esquema corto, que varían en duración y en los medicamentos administrados. Aquellos casos donde los pacientes que no finalizan su tratamiento se denominan Pérdida Del Seguimiento (PDS), aumentando los riesgos para el paciente y para la comunidad. En esta investigación se desarrolla un modelo predictivo, basándose en los datos del tratamiento de 3 grupos de pacientes con tuberculosis farmacorresistente en Ecuador entre los años 2010 y 2015, el cual permite concluir que la aplicación del régimen corto de tratamiento posibilita reducir a casi la mitad el número de pacientes que interrumpen su asistencia al programa, en comparación al régimen largo de 2 años, aunado a que factores como los desafíos psicológicos, las dificulades financieras o los efectos secundarios de los medicamentos pueden tener menor impacto en el paciente que es tratado en menor tiempo(AU)

Diverse drugs to fight the Mycobacterium tuberculosis complex, which causes tuberculosis, have been used for several decades, collaterally resulting in the mutation of strains resistant to one or more of these drugs. Multi-drug resistant tuberculosis, identified as MDR-TB, is a form of tuberculosis caused by bacteria that do not respond to isoniazid and rifampin, the most effective first-line drugs. The World Health Organization (WHO) describes two treatment schemes with second-line drugs for these patients: the traditional long scheme, and the more recent short scheme, which vary in duration and in the drugs administered. Those cases where patients who do not finish their treatment are called Loss Of Follow-up, increasing the risks for the patient and the community. In this research, a predictive model is developed, based on data from the treatment of 3 groups of patients with drug-resistant tuberculosis in Ecuador between 2010 and 2015, which allows to conclude that the application of the short treatment regimen makes it possible to reduce by almost half the number of patients who interrupt their attendance to the program, compared to the long regimen of 2 years, joined factors such as psychological challenges, financial difficulties or side effects of medications may have less impact on the patient who is treated in less time(AU)

Fatores associados às perdas de seguimento de crianças expostas ao HIV: um estudo no município de Porto Alegre / Factors associated with losses to follow-up in HIV-exposed children: a study in the city of Porto Alegre

Introdução: Apesar das condutas disponíveis para evitar a transmissão vertical do HIV, existem cenários como Porto Alegre, que permanecem com elevadas taxas. Perda de seguimento é aquela criança que foi exposta ao HIV, e que no momento do encerramento do caso, não foi localizada na rede de saúde para a realização de diagnóstico laboratorial. Objetivo: Analisar as "perdas de seguimentos" de crianças expostas à transmissão vertical do HIV e os fatores associados, no município de Porto Alegre. Métodos: Trata-se de um estudo de coorte histórica, no período de 2000 a 2017. Os dados foram coletados do Sistema de Informação de Agravos de Notificação. Foram investigadas informações relativas à mãe e a criança. Comparações foram realizadas por meio do teste de homogeneidade de proporções baseado na estatística de qui-quadrado de Pearson. Preditores foram investigados por modelo de regressão de Poisson com variação robusta. Resultados: Entre as 8.520 crianças expostas ao HIV, 1.762 (25,9%) foram classificadas como perda de seguimento. O perfil demográfico das mães de crianças perda de seguimento é de mulheres entre 21 a 35 anos (71,1%), predominantemente com 4 a 7 anos de estudo (49,9%), e brancas (53,9%). Em 78,4% dos casos o pré-natal não foi iniciado no primeiro trimestre (p<0,001). Estiveram associados à perda de seguimento os seguintes fatores socioeconômicos, comportamentais e de saúde das gestantes: ter até 20 anos de idade (OR = 1,47, IC95%: 1,17-1,84) ou 21 a 35 anos (OR = 1,34, IC95%: 1,09-1,64); se autodeclarar como preta (OR = 1,11, IC95% 1,01-1,24); fazer uso de drogas injetáveis (OR = 1,21, IC95%: 1,04-1,42), diagnóstico de HIV durante o pré-natal ou parto (OR = 1,32, IC95%: 1,19-1,47), e iniciar o pré-natal após o primeiro trimestre (OR = 1,22, IC95%: 1,08-1,39). Conclusão: Um expressivo percentual de gestante apresentou início tardio de pré-natal. Os preditores da perda de seguimento, que foram: idade mais jovem, autodeclarar raça/cor preta, uso de drogas injetáveis, diagnóstico de HIV no pré-natal ou parto e início tardio do pré-natal, remetem aos contextos de vulnerabilidade individual, social e programático que as gestantes estão inseridas.

Introduction: Despite the available conducts to prevent mother-to-child transmission of HIV, there are scenarios, such as Porto Alegre, that remain with high rates. Loss to follow-up is a child exposed to HIV who, at the time of case closure, was not located in the health network for laboratory diagnosis. Objective: To analyze the "loss to follow-up" of children exposed to mother-to-child transmission of HIV and the associated factors in the municipality of Porto Alegre. Methods: This is a historical cohort study from 2000 to 2017. Data were collected from the Notifiable Diseases Information System. Information regarding the mother and the child were investigated. Comparisons were made using the homogeneity of proportions test based on Pearson's chi-square statistic. Predictors were investigated using the Poisson's regression model with robust variation. Results: Among the 8,520 children exposed to HIV, 1,762 (25.9%) were classified as loss to follow-up. The demographic profile of mothers of children lost to follow-up is of women aged 21 to 35 years (71.1%), predominantly with 4 to 7 years of education (49.9%), and white (53.9%). In 78.4% of the cases, prenatal care was not started in the first trimester (p<0.001). The following socioeconomic, behavioral, and health factors were associated with loss to follow-up: being up to 20 years old (aRR 1.47; 95% CI 1,17-1,84) or 21 to 35 years old (aRR 1.34; 95% CI 1,09-1,64); self-reporting as black (aRR 1.11; 95% CI 1,01-1,24); using injective drugs (aRR 1.21; 95% CI 1,04-1,42); HIV diagnosis during prenatal care or childbirth (aRR 1.32; 95% CI 1,19-1,47); and late entry into prenatal care (aRR 1.22; 95% CI 1,08-1,39). Conclusion: A significant percentage of pregnant women had delayed prenatal care. The predictors of loss to follow-up, which were: younger age, self-reporting black race/color, use of injectable drugs, HIV diagnosis during prenatal care or childbirth, and late initiation of prenatal care, refer to the contexts of individual, social, and programmatic vulnerability in which pregnant women are inserted.

Tuberculosis Infection and Incidence of Loss to Follow Up among HIV Patients at Saiful Anwar General Hospital, Indonesia: A Retrospective Study

@#Introduction: Tuberculosis (TB) is the most common opportunistic infection experienced by HIV patients that can affect the success of antiretroviral (ARV) therapy. This study aimed to determine the association between tuberculosis infection and loss to follow-up (LTFU) among HIV patients after ARV therapy initiation. Methods: This retrospective cohort study was conducted by observing HIV patients in Saiful Anwar General Hospital, Indonesia who were diagnosed in 2015 for 39 months based on medical records data. The number of samples that met the inclusion and exclusion criteria was 170 patients. Kaplan Meier and Cox Regression were the statistical tests used to analyze data in this study. Results: The probability of HIV patients to retain in ARV therapy for 39 months was 90% among HIV co-infected TB patients and 84% among HIV without TB co-infection. However, no significant difference was found (p-value = 0.41). Most of the incidence of LTFU in both groups occurred in the first year after ARV initiation. Cox Regression analysis showed that TB infection did not have a significant relationship with the incidence of LTFU ARV therapy (HR 0.62; 95% CI 0.18 – 2.08; p-value = 0.44). Conclusion: This study found that TB infection did not have a significant association with LTFU after ARV initiation. However, most of LTFU in both groups (the co-infection group and without TB co-infection) occurred in the first year of ARV therapy. Providing intensive counseling in the initial phase could increase the commitment of HIV patients for staying in ARV therapy.

WeChat-based education and rehabilitation program in unprotected left main coronary artery disease patients after coronary artery bypass grafting: an effective approach in reducing anxiety, depression, loss to follow-up, and improving quality of life

This study aimed to investigate the effect of WeChat-based education and rehabilitation program (WERP) on anxiety, depression, health-related quality of life (HRQoL), major adverse cardiac/cerebrovascular events (MACCE)-free survival, and loss to follow-up rate in unprotected left main coronary artery disease (ULMCAD) patients after coronary artery bypass grafting (CABG). In this randomized controlled study, 140 ULMCAD patients who underwent CABG were randomly assigned to WERP group (n=70) or control care (CC) group (n=70). During the 12-month intervention period, anxiety and depression (using hospital anxiety and depression scale (HADS)) and HRQoL (using 12-Item Short-Form Health Survey (SF-12)) were assessed longitudinally. During the total 36-month follow-up period (12-month intervention and 24-month non-intervention periods), MACCE and loss to follow-up were recorded. During the intervention period, HADS-anxiety score at month 9 (M9) (P=0.047) and month 12 (M12) (P=0.034), anxiety rate at M12 (P=0.028), and HADS-D score at M12 (P=0.048) were all reduced in WERP group compared with CC group. As for HRQoL, SF-12 physical component summary score at M9 (P=0.020) and M12 (P=0.010) and SF-12 mental component summary score at M9 (P=0.040) and M12 (P=0.028) were all increased in WERP group compared with CC group. During the total follow-up period, WERP group displayed a trend of longer MACCE-free survival than that in CC group but without statistical significance (P=0.195). Additionally, loss to follow-up rate was attenuated in WERP group compared with CC group (P=0.033). WERP serves as an effective approach in optimizing mental health care and promoting life quality in ULMCAD patients after CABG.

Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil / Adesão ao tratamento de pacientes com paracoccidioidomicose na Região Centro-Oeste do Brasil

ABSTRACT Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

RESUMO Objetivo: Avaliar a adesão ao tratamento de paracoccidioidomicose. Métodos: Estudo conduzido com 188 pacientes com paracoccidioidomicose atendidos em um hospital terciário na Região Centro-Oeste do Brasil, de 2000 a 2010, para avaliar adesão ao tratamento. Foram considerados aderentes pacientes que tiveram o seguinte critério: retiraram os medicamentos na farmácia e autorrelataram a utilização de, no mínimo, 80% de dispensação dos antifúngicos prescritos na última consulta. Resultados: A maioria dos pacientes era homem (95,7%), tinha a forma crônica da doença (94,2%) e foi tratada com sulfametoxazol/trimetropim (86,2%). Apenas 44,6% dos pacientes aderiram ao tratamento. A maior perda de seguimento foi observada nos primeiros 4 meses de tratamento (p < 0,02). Adesão ao tratamento foi maior em pacientes com do que sem envolvimento pulmonar (RC: 2,986; IC95% 1,351-6,6599) e maior para os pacientes com do que sem tuberculose associada (RC 2,763; IC95% 1,004-7,604). Conclusões: A adesão ao tratamento da paracoccidioidomicose foi baixa e os primeiros 4 meses constituíram o período com maior evasão. Pacientes com envolvimento paracocidióidico pulmonar ou tuberculose associada revelaram maior adesão ao tratamento da paracoccidioidomicose.

Adherencia al seguimiento y evolución de la lesión en mujeres con NIC 1 / Adherence to follow-up and outcome of lesions in women with grade 1 cervical intraepithelial neoplasia

Resumen Objetivo: Determinar la adherencia al seguimiento y la evolución de las lesiones en mujeres con diagnóstico de NIC 1. Metodología: Fueron seleccionadas mujeres no embarazadas, mayores de 18 años de edad, remitidas a colposcopia, sin antecedentes de NIC, histerectomía previa o terapia ablativa en el cuello uterino, que obtuvieron diagnóstico por biopsia de NIC 1 y fueron sometidas a manejo expectante. Se les aplicó un cuestionario de factores de riesgo y se documentó el resultado de la citología previa a colposcopia. El seguimiento consistió en examen citológico y colposcópico cada 6 meses durante 1 año. Se consideraron no adherentes aquellas que a los 15 meses no contaron con evaluaciones (citología y colposcopia / colposcopia) o tratamientos documentados. Resultados: Se incluyó a 40 mujeres, de 95 elegibles con NIC 1. La tasa de deserción fue de 17/40 (42,5%). Las variables demográficas y clínicas más frecuentemente asociadas a no-adherencia a seguimiento fueron la nuliparidad y el inicio temprano de las relaciones sexuales. La evolución de lesión de bajo grado a alto grado pudo observarse en el 4,3% y el abandono del manejo conservador a terapia invasiva fue 22,5%. Conclusión: Hubo una alta tasa de pérdida de seguimiento y deserción del manejo conservador hacia terapia invasiva. Un gran porcentaje de pacientes sufrió regresión de la NIC 1. El estudio ayudará a aclarar las estrategias óptimas para el manejo de las anormalidades cervicales de bajo grado en poblaciones con bajas condiciones socioculturales.

Abstract Objective: To determine adherence to follow-up and outcome of lesions in women diagnosed with grade 1 cervical intraepithelial neoplasia (CIN 1). Methodology: The study included non-pregnant women aged 18 or older, referred for col poscopy, with a colposcopy directed biopsy diagnosis of CIN 1, with no history of prior CIN, hysterectomy or cervical ablative therapy. Participants answered a questionnaire on risk fac tors, and the outcome of previous cytology and colposcopy was documented. All women should have been followed up for 1 year with cytology and colposcopy every six months. Those who did not have cytology and colposcopy / colposcopy assessments or documented treatments after 15 months were considered as non-adherent. Results: A total of 40 patients with CIN 1 were included. The loss to follow-up rate of loss was 17/40 (42.5%). The demographic and clinical variables most frequently associated with non-adherence to follow-up were null parity and early initiation of sexual intercourse. The progression of low-grade to high-grade lesion was observed in 4.3%. 22.5% failed Conservative treatment failed conservative treatment and moved to invasive therapy. Conclusion: The rate of loss to follow-up was high, with a considerable referral from conser vative to invasive therapy. A large percentage of patients had regression of CIN 1. This study should help clarify the optimal strategies for the treatment of women with low-grade cervical abnormalities in populations of low sociocultural conditions and high risk of cervical cancer.

Description and Factors Affecting the Referral of Presumptive Tuberculosis Patients in China / 生物医学与环境科学（英文）

To describe and analyze the factors affecting the referral of presumptive tuberculosis patients between health-care facilities that are not affiliated with the National TB Control Program (NTP) and NTP-designated medical facilities in China, we carried out a retrospective study based on data collected in the Tuberculosis Information Management System in 2015. Out of 324,221 presumptive pulmonary tuberculosis (PTB) cases reported by non-NTP health-care facilities, 302,006 (93.1%) reported cases successfully arrived at designated medical facilities and 22,215 cases (6.9%) were lost to follow-up. The arrival rate of presumptive cases among male patients (92.9%) was slightly lower than that among female ones (93.7%), and this difference is statistically significant. The majority (73.3%) of reported cases were local permanent residents. Migrants have a higher risk of being lost to follow-up compared with local residents (adjusted odds ratios 4.126 and 5.003, respectively). Compared with farmers and herdsmen, pre-school children, unemployed laborers, retirees, and people with other occupations (adjusted odds ratios 2.361, 1.274, 1.068, and 1.993, respectively) had higher rates of loss to follow-up during the referral and tracing processes. In conclusion, this study demonstrates that the high referral rate of presumptive TB cases from non-NTP health-care facilities to designated medical facilities in China is due to implementation of effective active case identification strategies. In addition, migrant populations, pre-school children, unemployed laborers, and retirees were identified as high-risk groups that contribute to the loss to follow-up.

A study on the factors affecting the follow-up participation in birth cohorts

OBJECTIVES: A stable follow-up participation rate is a very important factor for validity in a cohort study. This study analyzed the factors that affect the participation rate at one hospital-based birth cohort in South Korean. METHODS: The participants were recruited from the Mothers' and Children's Environmental Health study between 2006 and 2010. The analysis targeted 1751 mothers who participated in a birth cohort. We conducted analyses of general characteristics during pregnancy and those of infants at birth that affect the participation rate of the 6-month follow-up survey. RESULTS: The participation rate for the 6-month follow-up survey was 60.4%. The participation rate in the follow-up of the subsequent period decreased within a 5% to 10% range compared to the number of subjects. The participation rate of premature infants was 16.9% lower than that of a full-term infant (52.6% vs. 69.5%). Analysis showed a 16.7% difference between the participation rate of low-birthweight infants in follow-ups (53.7%) and the participation rate of infants with normal weight (70.4%). The participation rate of mothers who were employed during pregnancy was significantly lower for the 6-month follow-up compared to the participation rate of mothers who were unemployed during pregnancy. CONCLUSIONS: In this study, factors such as premature birth, low-birthweight, and the employment status of the mother during pregnancy affected the participation rate of the follow-up survey for the birth cohort at six months. A specific strategy is needed to encourage survey participation for the high risk groups in the follow-ups.

Causes of Death and Risk Factors for Mortality among HIV-Infected Patients Receiving Antiretroviral Therapy in Korea

A retrospective study was conducted to determine the mortality, causes and risk factors for death among HIV-infected patients receiving antiretroviral therapy (ART) in Korea. The outcomes were determined by time periods, during the first year of ART and during 1-5 yr after ART initiation, respectively. Patients lost to follow-up were traced to ascertain survival status. Among 327 patients initiating ART during 1998-2006, 68 patients (20.8%) died during 5-yr follow-up periods. Mortality rate per 100 person-years was 8.69 (95% confidence interval, 5.68-12.73) during the first year of ART, which was higher than 4.13 (95% confidence interval, 2.98-5.59) during 1-5 yr after ART. Tuberculosis was the most common cause of death in both periods (30.8% within the first year of ART and 16.7% during 1-5 yr after ART). During the first year of ART, clinical category B and C at ART initiation, and underlying malignancy were significant risk factors for mortality. Between 1 and 5 yr after ART initiation, CD4 cell count < or = 50 cells/microL at ART initiation, hepatitis B virus co-infection, and visit constancy < or = 50% were significant risk factors for death. This suggests that different strategies to reduce mortality according to the time period after ART initiation are needed.