Single retinal image for diabetic retinopathy screening: performance of a handheld device with embedded artificial intelligence.

BACKGROUND: Diabetic retinopathy (DR) is a leading cause of blindness. Our objective was to evaluate the performance of an artificial intelligence (AI) system integrated into a handheld smartphone-based retinal camera for DR screening using a single retinal image per eye. METHODS: Images were obtained from individuals with diabetes during a mass screening program for DR in Blumenau, Southern Brazil, conducted by trained operators. Automatic analysis was conducted using an AI system (EyerMaps™, Phelcom Technologies LLC, Boston, USA) with one macula-centered, 45-degree field of view retinal image per eye. The results were compared to the assessment by a retinal specialist, considered as the ground truth, using two images per eye. Patients with ungradable images were excluded from the analysis. RESULTS: A total of 686 individuals (average age 59.2 ± 13.3 years, 56.7% women, diabetes duration 12.1 ± 9.4 years) were included in the analysis. The rates of insulin use, daily glycemic monitoring, and systemic hypertension treatment were 68.4%, 70.2%, and 70.2%, respectively. Although 97.3% of patients were aware of the risk of blindness associated with diabetes, more than half of them underwent their first retinal examination during the event. The majority (82.5%) relied exclusively on the public health system. Approximately 43.4% of individuals were either illiterate or had not completed elementary school. DR classification based on the ground truth was as follows: absent or nonproliferative mild DR 86.9%, more than mild (mtm) DR 13.1%. The AI system achieved sensitivity, specificity, positive predictive value, and negative predictive value percentages (95% CI) for mtmDR as follows: 93.6% (87.8-97.2), 71.7% (67.8-75.4), 42.7% (39.3-46.2), and 98.0% (96.2-98.9), respectively. The area under the ROC curve was 86.4%. CONCLUSION: The portable retinal camera combined with AI demonstrated high sensitivity for DR screening using only one image per eye, offering a simpler protocol compared to the traditional approach of two images per eye. Simplifying the DR screening process could enhance adherence rates and overall program coverage.

Toxic stress on a pediatric population during the COVID-19 pandemic.

OBJECTIVE: The aim of this study was to analyze the impact of social isolation as a result of the coronavirus-19 disease (COVID-19) pandemic in children and adolescents aged 0-17 years in Southern Brazil. METHODS: This is a cross-sectional study in which 542 questionnaires answered by parents or legal guardians of children and adolescents aged 0-17 years residing in the Brazilian South region, through Google Forms®. Questionnaires answered incompletely or from children outside the stipulated age group and from other regions of the country were excluded from the research. The collected data were organized into descriptive and association tables containing absolute and relative frequencies, medians, averages, standard deviations, quartile deviations, average, and proportion estimates in the form of 95% confidence intervals and the result of the chi-square test of independence. Data analysis was fulfilled with the application aid of Microsoft Excel 2016 and Epi Info version 7.2.1.0 of 01/27/2017. Statistically significant associations were considered when p<0.05. RESULTS: There was an increase in the perception of nervousness (62.7%), anxiety (67.7%), and sadness (51.3%) in children and adolescents during the pandemic period. This study evidenced a high prevalence of screens overuse (50.9%) and sedentary lifestyle (39.1%) in this age group during the period. Furthermore, the occurrence of regressive behaviors occurred more frequently in the age group of 3-6 years (57.1%) and between 7 and 10 years (44.6%). CONCLUSIONS: It is inferred from this study that one of the implications resulting from the pandemic period is the increase of toxic stress in the pediatric population.

Toxic stress on a pediatric population during the COVID-19 pandemic / Estresse tóxico em uma população pediátrica durante a pandemia de COVID-19

Abstract Objective: The aim of this study was to analyze the impact of social isolation as a result of the coronavirus-19 disease (COVID-19) pandemic in children and adolescents aged 0-17 years in Southern Brazil. Methods: This is a cross-sectional study in which 542 questionnaires answered by parents or legal guardians of children and adolescents aged 0-17 years residing in the Brazilian South region, through Google Forms®. Questionnaires answered incompletely or from children outside the stipulated age group and from other regions of the country were excluded from the research. The collected data were organized into descriptive and association tables containing absolute and relative frequencies, medians, averages, standard deviations, quartile deviations, average, and proportion estimates in the form of 95% confidence intervals and the result of the chi-square test of independence. Data analysis was fulfilled with the application aid of Microsoft Excel 2016 and Epi Info version 7.2.1.0 of 01/27/2017. Statistically significant associations were considered when p<0.05. Results: There was an increase in the perception of nervousness (62.7%), anxiety (67.7%), and sadness (51.3%) in children and adolescents during the pandemic period. This study evidenced a high prevalence of screens overuse (50.9%) and sedentary lifestyle (39.1%) in this age group during the period. Furthermore, the occurrence of regressive behaviors occurred more frequently in the age group of 3-6 years (57.1%) and between 7 and 10 years (44.6%). Conclusions: It is inferred from this study that one of the implications resulting from the pandemic period is the increase of toxic stress in the pediatric population.

RESUMO Objetivo: Analisar o impacto do isolamento social em decorrência da pandemia associada ao coronavírus 2019 (COVID-19), em crianças e adolescentes de zero a 17 anos da Região Sul do Brasil. Métodos: Trata-se de um estudo de corte transversal em que foram obtidos 542 questionários, respondidos por pais ou responsáveis legais de crianças e adolescentes de zero a 17 anos residentes da Região Sul brasileira, por meio do Google Forms®. Questionários respondidos de maneira incompleta ou de crianças fora da faixa etária estipulada e de outras regiões do país foram excluídos da pesquisa. Os dados colhidos foram organizados em tabelas descritivas e de associação contendo frequências absolutas, relativas, médias, medianas, desvios padrão, desvios quartílicos, estimativas de média e de proporção em forma de intervalos com 95% de confiança e resultado do teste do qui-quadrado de independência. A análise dos dados foi realizada com o auxílio dos aplicativos Microsoft Excel 2016 e Epi Info versão 7.2.1.0, de 27 de janeiro de 2017. Foram consideradas associações estatisticamente significativas quando p<0,05. Resultados: Houve aumento da percepção de nervosismo (62,7%), ansiedade (67,7%) e tristeza (51,3%) em crianças e adolescentes no período da pandemia. O estudo evidenciou alta prevalência de uso excessivo de telas (48,2%) e de sedentarismo (39,1%) nessa faixa etária durante o período. Ademais, a ocorrência de comportamentos regressivos ocorreu de maneira mais frequente nas faixas etárias de 3-6 anos (57,1%) e de 7-10 anos (44,6%). Conclusões: Infere-se deste estudo que uma das implicações do período da pandemia é o aumento do estresse tóxico na população pediátrica.