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1.
Environ Health Prev Med ; 26(1): 18, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522902

RESUMO

BACKGROUND: Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites. METHODS: 1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models. RESULTS: The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder. CONCLUSIONS: While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.


Assuntos
Análise Custo-Benefício , Vírus de Hepatite/isolamento & purificação , Programas de Rastreamento/instrumentação , Local de Trabalho , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade
2.
PLoS One ; 15(12): e0242408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315885

RESUMO

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.


Assuntos
Programas de Rastreamento/métodos , Mycobacterium tuberculosis/isolamento & purificação , Sistemas Automatizados de Assistência Junto ao Leito , Manejo de Espécimes/métodos , Tuberculose Pulmonar/diagnóstico , Brasil , DNA Bacteriano/isolamento & purificação , Humanos , Limite de Detecção , Programas de Rastreamento/economia , Programas de Rastreamento/instrumentação , Mycobacterium tuberculosis/genética , Estudo de Prova de Conceito , Reação em Cadeia da Polimerase em Tempo Real/economia , Reação em Cadeia da Polimerase em Tempo Real/instrumentação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Manejo de Espécimes/economia , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia
3.
PLoS One ; 15(8): e0236141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764751

RESUMO

BACKGROUND: Novel interventions are needed to reach young people and adult men with HIV services given the low HIV testing rates in these population sub-groups. We assessed the feasibility and acceptability of a peer-led oral HIV self-testing (HIVST) intervention in Kasensero, a hyperendemic fishing community (HIV prevalence: 37-41%) in Rakai, Uganda. METHODS: This study was conducted among young people (15-24 years) and adult men (25+ years) between May and August 2019. The study entailed distribution of HIVST kits by trained "peer-leaders," who were selected from existing social networks and trained in HIVST distribution processes. Peer-leaders received up to 10 kits to distribute to eligible social network members (i.e. aged 15-24 years if young people or 25+ years if adult man, not tested in the past 3 months, and HIV-negative or of unknown HIV status at enrolment). The intervention was evaluated against the feasibility benchmark of 70% of peer-leaders distributing up to 70% of the kits that they received; and the acceptability benchmark of >80% of the respondents self-testing for HIV. RESULTS: Of 298 enrolled into the study at baseline, 56.4% (n = 168) were young people (15-24 years) and 43.6% (n = 130) were adult males (25+ years). Peer-leaders received 298 kits and distributed 296 (99.3%) kits to their social network members. Of the 282 interviewed at follow-up, 98.2% (n = 277) reported that they used the HIVST kits. HIV prevalence was 7.4% (n = 21). Of the 57.1% (n = 12) first-time HIV-positives, 100% sought confirmatory HIV testing and nine of the ten (90%) respondents who were confirmed as HIV-positive were linked to HIV care within 1 week of HIV diagnosis. CONCLUSION: Our findings show that a social network-based, peer-led HIVST intervention in a hyperendemic fishing community is highly feasible and acceptable, and achieves high linkage to HIV care among newly diagnosed HIV-positive individuals.


Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Infuência dos Pares , Autocuidado/psicologia , Adolescente , Adulto , Doenças Endêmicas , Estudos de Viabilidade , Seguimentos , Anticorpos Anti-HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Liderança , Masculino , Masculinidade , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Mucosa Bucal/imunologia , Projetos Piloto , Prevalência , Kit de Reagentes para Diagnóstico , População Rural/estatística & dados numéricos , Autocuidado/instrumentação , Autocuidado/métodos , Uganda/epidemiologia , Adulto Jovem
4.
Acta Diabetol ; 57(12): 1493-1499, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32748176

RESUMO

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.


Assuntos
Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Fotografação/métodos , Retina/diagnóstico por imagem , Telemedicina/métodos , Adulto , Idoso , Brasil , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico por imagem , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Encaminhamento e Consulta , Smartphone , Telemedicina/instrumentação
5.
Sante Publique ; Vol. 32(1): 9-17, 2020 Jun 18.
Artigo em Francês | MEDLINE | ID: mdl-32706230

RESUMO

INTRODUCTION: Preschool children develop early literacy skills that are predictive of their reading acquisition.Purpose of research: This study aims to use a short screening tool to examine emergent literacy performances. It includes 4-5-year-old children (N = 14,820) schooled in public and private schools in France. A number of public schools are labelled as with educational needs (Priority education network, REP). Children were assessed in three domains, letter-name knowledge, phonological skills and vocabulary. RESULTS: It is shown that children schooled in REP have poorer scores than children schooled out of REP. We observe no significant difference between scores in children schooled in private schools and public schools out of REP. A significant effect of gender and age is observed, the first in favor of girls and the second in favor of older children. The effect of gender diminishes with the age, the difference between girls and boys becoming smaller. Finally, we examined the distribution of performances in the three domains of children who obtained the lowest scores. CONCLUSIONS: A short screening tool to examine directly the literacy skills in preschool children is an opportunity to define and coordinate preventive actions and appropriate early interventions to help lessen difficulties in learning to read.


Assuntos
Alfabetização/estatística & dados numéricos , Programas de Rastreamento/instrumentação , Pré-Escolar , Feminino , França , Humanos , Masculino
7.
Rev. andal. med. deporte ; 13(2): 114-119, jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-194375

RESUMO

OBJETIVO: dar a conocer el protocolo diseñado por el Centro Andaluz de Medicina del Deporte, para el cribado de la infección por SARS-CoV-2 en deportistas. MÉTODO: consenso de los profesionales del Centro Andaluz de Medicina del Deporte y tras revisar los protocolos existentes para cribado del cuadro clínico COVID-19. RESULTADOS: se ha elaborado un protocolo para el cribaje de la infección por SARS-CoV-2 en deportistas que consta de un protocolo de actuación, un cuestionario de cribado, una base de datos en la que se incluye todo el seguimiento de los deportistas y un sistema para emitir informe de aptitud al deportista. CONCLUSIÓN: se propone un protocolo completo para el cribaje de COVID-19, específicamente diseñado para su aplicación en el ámbito del deporte, para el fomento de una práctica deportiva segura


OBJECTIVE: to publicize the protocol designed by the Andalusian Center for Sports Medicine, for the screening of SARS-CoV-2 infection in athletes. METHOD: consensus of the professionals of the Andalusian Center for Sports Medicine and after reviewing the existing protocols for screening the clinical situation COVID-19. RESULTS: A protocol for the screening of SARS-CoV-2 infection in athletes has been developed, which consists of an action plan, a screening questionnaire, a database that includes the entire monitoring of athletes and a system to issue a fitness report to the athlete. CONCLUSION: a complete protocol for the screening of COVID-19 is proposed, specifically designed for its application in the field of sport, to promote safe sports practice


OBJETIVO: divulgar o protocolo elaborado pelo Centro Andaluz de Medicina Esportiva, para rastreamento de infecção por SARS-CoV-2 em atletas. MÉTODO: consenso dos profissionais do Centro Andaluz de Medicina Esportiva e após revisão dos protocolos existentes para triagem do quadro clínico COVID-19. RESULTADOS: foi desenvolvido um protocolo para a triagem da infecção por SARS-CoV-2 em atletas, composto por um protocolo de ação, um questionário de triagem, um banco de dados que inclui todo o monitoramento de atletas e um sistema para emitir um relatório de condicionamento físico ao atleta. CONCLUSÃO: é proposto um protocolo completo para a triagem do COVID-19, projetado especificamente para sua aplicação no campo do esporte, para a promoção de práticas esportivas seguras


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Pandemias , Atletas , Protocolos Clínicos , Inquéritos e Questionários , Programas de Rastreamento/instrumentação
8.
Immunol Rev ; 295 Suppl s1: 4-10, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32329102

RESUMO

The ongoing outbreak of the novel coronavirus (SARS-CoV-2) infection is creating serious challenges for health laboratories that seek to identify viral infections as early as possible, optimally at the earliest appearance of symptom. Indeed, there is urgent need to develop and deploy robust diagnostic methodologies not only to use in health laboratory environments but also directly in places where humans circulate and spread the virus such as airports, trains, boats, and any public aggregation places. The success of a reliable and sensitive asymptomatic diagnosis relies on the identification and measurement of informative biomarkers from human host and virus in a rapid, sensitive, and inexpensive manner. The objective of this article is to describe an innovative multidisciplinary approach to develop an efficient, inexpensive, and easy-to-use portable instrument (bCUBE® by Hyris Ltd) that can be employed as a surveillance system for the emergency caused by SARS-CoV-2. A solution for Coronavirus testing, compliant with CDC guidelines, is scheduled to be released in the next weeks. In addition, we will describe a workflow and path of an integrated multi-omic approach that will lead to host and pathogen biomarker discovery in order to train the instrument to provide reliable results based on a specific biomarker's fingerprint of SARS-CoV-2 infection.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/instrumentação , Infecções por Coronavirus/diagnóstico , Surtos de Doenças/prevenção & controle , Programas de Rastreamento/instrumentação , Pneumonia Viral/diagnóstico , Animais , Infecções Assintomáticas/epidemiologia , Biomarcadores/análise , Serviços de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fluxo de Trabalho
9.
Codas ; 32(4): e20190132, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32321007

RESUMO

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.


Assuntos
Transtornos de Deglutição/diagnóstico , Músculos Faciais/fisiopatologia , Mandíbula/fisiopatologia , Programas de Rastreamento/instrumentação , Transtornos da Articulação Temporomandibular/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/fisiopatologia , Medição da Dor , Sensibilidade e Especificidade , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto Jovem
10.
Eur Eat Disord Rev ; 28(4): 433-444, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32243021

RESUMO

OBJECTIVE: A significant proportion of individuals with anorexia nervosa (AN) show high levels of autism spectrum disorder (ASD) traits, a factor associated with poorer treatment outcomes. An important question for both researchers and clinicians relates to how ASD traits should be assessed in individuals with AN. This study aimed to examine scores on the Social Responsiveness Scale adult self-report version (SRS-2) in individuals in the acute (AN) and recovered stages (REC) of illness compared to healthy controls (HCs). We also aimed to examine associations between the SRS-2 and an observational diagnostic measure, the Autism Diagnostic Observation Schedule - second edition (ADOS-2). METHOD: The SRS-2 and ADOS-2 were administered to 142 adults with AN, REC, and HCs. Eating disorder (ED) psychopathology and functional impairment were also assessed. RESULTS: AN and REC scored significantly higher than HCs on the SRS-2. SRS-2 scores significantly predicted ADOS-2 classification and were positively associated with ED psychopathology and functional impairment. SRS-2 scores were not associated with BMI or illness duration. CONCLUSIONS: The SRS-2 may be a useful tool in screening for ASD traits in individuals with AN. Although cross-sectional, the results also suggest ASD symptoms are independent of BMI and persist in individuals recovered from AN.


Assuntos
Anorexia Nervosa/psicologia , Transtorno do Espectro Autista/diagnóstico , Programas de Rastreamento/instrumentação , Escalas de Graduação Psiquiátrica , Comportamento Social , Adulto , Transtorno do Espectro Autista/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Autorrelato , Adulto Jovem
11.
J Laryngol Otol ; 134(4): 311-315, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32238202

RESUMO

OBJECTIVE: To explore the feasibility of constructing a proof-of-concept artificial intelligence algorithm to detect tympanic membrane perforations, for future application in under-resourced rural settings. METHODS: A retrospective review was conducted of otoscopic images analysed using transfer learning with Google's Inception-V3 convolutional neural network architecture. The 'gold standard' 'ground truth' was defined by otolaryngologists. Perforation size was categorised as less than one-third (small), one-third to two-thirds (medium), or more than two-thirds (large) of the total tympanic membrane diameter. RESULTS: A total of 233 tympanic membrane images were used (183 for training, 50 for testing). The algorithm correctly identified intact and perforated tympanic membranes (overall accuracy = 76.0 per cent, 95 per cent confidence interval = 62.1-86.0 per cent); the area under the curve was 0.867 (95 per cent confidence interval = 0.771-0.963). CONCLUSION: A proof-of-concept image-classification artificial intelligence algorithm can be used to detect tympanic membrane perforations and, with further development, may prove to be a valuable tool for ear disease screening. Future endeavours are warranted to develop a point-of-care tool for healthcare workers in areas distant from otolaryngology.


Assuntos
Inteligência Artificial/normas , Otoscopia/métodos , Perfuração da Membrana Timpânica/diagnóstico , Membrana Timpânica/diagnóstico por imagem , Algoritmos , Estudos de Viabilidade , Humanos , Programas de Rastreamento/instrumentação , Redes Neurais de Computação , Estudos Retrospectivos , Membrana Timpânica/anatomia & histologia , Membrana Timpânica/patologia , Perfuração da Membrana Timpânica/patologia
12.
J Am Med Inform Assoc ; 27(6): 967-971, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32240303

RESUMO

Emergent policy changes related to telemedicine and the Emergency Medical Treatment and Labor Act during the novel coronavirus disease 2019 (COVID-19) pandemic have created opportunities for technology-based clinical evaluation, which serves to conserve personal protective equipment (PPE) and protect emergency providers. We define electronic PPE as an approach using telemedicine tools to perform electronic medical screening exams while satisfying the Emergency Medical Treatment and Labor Act. We discuss the safety, legal, and technical factors necessary for implementing such a pathway. This approach has the potential to conserve PPE and protect providers while maintaining safe standards for medical screening exams in the emergency department for low-risk patients in whom COVID-19 is suspected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência , Programas de Rastreamento/métodos , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Telemedicina , Infecções por Coronavirus/epidemiologia , Serviços Médicos de Emergência/legislação & jurisprudência , Regulamentação Governamental , Humanos , Programas de Rastreamento/instrumentação , Programas de Rastreamento/legislação & jurisprudência , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/legislação & jurisprudência , Estados Unidos
13.
Z Gerontol Geriatr ; 53(3): 239-244, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32123997

RESUMO

BACKGROUND: Oropharyngeal dysphagia is widespread in geriatric patients and is nearly always multicausal. It is often insufficiently recognized and leads to severe complications. The available and established screening tools all focus primarily on patients with neurological diseases, usually following a stroke. MATERIAL AND METHODS: The working group on dysphagia of the German Society of Geriatrics (DGG), which is comprised of physicians, speech and language therapists and dysphagia therapists, performed a literature review on dysphagia screening tools. Based on the results of the literature search and own experience, a new screening instrument suitable for geriatric patients was developed and agreed by the consensus group. RESULTS: The new screening instrument for the detection of oropharyngeal dysphagia in geriatric patients consists of three parts: 1) consciousness and posture control while sitting, 2) ability to swallow saliva and to cough as well as tongue motility and 3) the water swallowing test. The screening can be applied by trained medical personnel and can easily be integrated into everyday practice. CONCLUSION: The new screening tool is especially aimed at geriatric patients. It has advantages compared to previously recommended screening tests. Initial experiences with the instrument show good practicability and acceptance in geriatric teams. Further studies have to test the validity of the instrument.


Assuntos
Transtornos de Deglutição/diagnóstico , Geriatria , Programas de Rastreamento/instrumentação , Acidente Vascular Cerebral/diagnóstico , Idoso , Deglutição , Avaliação Geriátrica , Humanos , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Acidente Vascular Cerebral/etiologia
14.
J Laryngol Otol ; 134(4): 350-353, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32172698

RESUMO

OBJECTIVES: Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae. METHODS: A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy. RESULTS: In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively. CONCLUSION: Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.


Assuntos
Fístula Cutânea/diagnóstico por imagem , Diatrizoato de Meglumina/administração & dosagem , Fluoroscopia/métodos , Laringectomia/efeitos adversos , Doenças Faríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Fístula Cutânea/prevenção & controle , Fístula Cutânea/terapia , Feminino , Fluoroscopia/tendências , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Faringe/patologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Mil Med ; 185(Suppl 1): 342-347, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074360

RESUMO

INTRODUCTION: The goal of the present study was to characterize behavioral health rates, behavioral health care utilization, loneliness, and perceived prejudice and support among sexual minority soldiers. MATERIALS AND METHODS: Cross-sectional survey data were obtained from 640 active-duty U.S. soldiers enrolled in an academic training institute who provided information on their sexual orientation. Survey topics included demographics, behavioral health, behavioral health care utilization, and mitigating factors (eg, perceived prejudice, perceived support, and loneliness). Chi-square analyses were utilized to determine any differences between groups for behavioral health rates and behavioral health care utilization. Robust regression was used for analysis of self-reported loneliness. RESULTS: A higher proportion of lesbian, gay, bisexual (LGB) soldiers than heterosexual soldiers screened positive for anxiety, post-traumatic stress disorder, and suicidality. No between-group differences in behavioral health care utilization were found; however, a higher proportion of LGB soldiers sought help from military family life counselors. No between-group differences for loneliness were found. Finally, perceived prejudice was higher for LGB soldiers and perceived support was lower. CONCLUSION: Organizational barriers, such as perceived prejudice and lack of support, appear to still exist for sexual minority soldiers. Increasing organizational support and implementing training and education for health care providers in order to better support the LGB soldier community may mitigate these barriers.


Assuntos
Programas de Rastreamento/métodos , Militares/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/estatística & dados numéricos , Militares/estatística & dados numéricos , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
16.
BMC Palliat Care ; 19(1): 18, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041616

RESUMO

BACKGROUND: While the populations of children who can benefit from paediatric palliative care (PPC) have been broadly defined, identifying individual patients to receive PPC has been problematic in practice. The Paediatric Palliative Screening scale (PaPaS) is a multi-dimensional tool that assesses palliative care needs in children and families to facilitate timely referrals. This study evaluates its use to manage new referrals and ongoing review of patients receiving home-based PPC in Singapore. METHODS: Using a retrospective cohort study design, 199 patients admitted to receive PPC via clinician screening were scored using PaPaS. Eighty-four patients in two groups were scored again at one of two following milestones: one-year service continuation mark or point of discharge before a year. Accuracy measures were compared against clinical assessment. RESULTS: 96.98% of patients scored 15 and above on admission (indicating need for PPC). Patients assessed at following milestones were effectively stratified; those who continued to receive service after 1 year scored significantly higher (M = 19.23) compared to those who were discharged within a year (M = 7.86). Sensitivity and specificity for PaPaS were calculated at 82.54 and 100% respectively. Overall congruence with clinician-based decisions supports the utility of PaPaS as a screening tool in PPC. Recommendations to improve the scale further are proposed. CONCLUSION: The PaPaS is a practical screening tool that signposts PPC needs within the clinical setting. This facilitates early referrals to PPC, without having to specify individual prognoses that are often uncertain. Other benefits include optimised continuity of care and implications for resource allocation.


Assuntos
Programas de Rastreamento/instrumentação , Cuidados Paliativos/métodos , Psicometria/normas , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pediatria/métodos , Pediatria/tendências , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Singapura , Adulto Jovem
17.
PLoS One ; 15(2): e0228772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040491

RESUMO

Lyme disease (LD) diagnosis using the current two-tier algorithm is constrained by low sensitivity for early-stage infection and ambiguity in determining treatment response. We recently developed a protein microarray biochip that measures diagnostic serum antibody targets using grating-coupled fluorescent plasmonics (GC-FP) technology. This strategy requires microliters of blood serum to enable multiplexed biomarker screening on a compact surface and generates quantitative results that can be further processed for diagnostic scoring. The GC-FP biochip was used to detect serum antibodies in patients with active and convalescent LD, as well as various negative controls. We hypothesized that the quantitative, high-sensitivity attributes of the GC-FP approach permit: 1) screening of antibody targets predictive for LD status, and 2) development a diagnostic algorithm that is more sensitive, specific, and informative than the standard ELISA and Western blot assays. Notably, our findings led to a diagnostic algorithm that may be more sensitive than the current standard for detecting early LD, while maintaining 100% specificity. We further show that analysis of relative antibody levels to predict disease status, such as in acute and convalescent stages of infection, is possible with a highly sensitive and quantitative platform like GC-FP. The results from this study add to the urgent conversation regarding better diagnostic strategies and more effective treatment for patients affected by tick-borne disease.


Assuntos
Anticorpos Antibacterianos/sangue , Fluorescência , Dispositivos Lab-On-A-Chip , Doença de Lyme/sangue , Doença de Lyme/diagnóstico , Programas de Rastreamento/instrumentação , Humanos , Doença de Lyme/imunologia , Fatores de Tempo
18.
J Pediatr ; 219: 54-61.e1, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32106963

RESUMO

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.


Assuntos
Programas de Rastreamento/instrumentação , Transtornos Mentais/diagnóstico , Autoavaliação , Adolescente , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
PLoS One ; 15(1): e0227198, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935228

RESUMO

INTRODUCTION: The first 90 of the 90-90-90 initiative introduced by the World Health Organization(WHO) in 2015 requires 90% of people with HIV be aware of their status by 2020. In South Africa, conventional facility-based testing had reached 84.9% in 2018; innovative new methods, like HIV self-testing(HIVST) may close the testing gap. This study aimed to determine the usability of seven HIVST kits among untrained South Africans. METHODS: This cross-sectional study of 1400 adults in Johannesburg evaluated the usability of five blood fingerstick and two oral fluid HIVSTs, using WHO prequalification criteria, from June 2016 to June 2018. Participants were handed one kit, with no further information about the device or test procedure, and asked to perform the test in front of an observer. The observer used product-specific semi-structured questionnaires organized into a composite usability index(UI) using a HIVST process checklist, a contrived results interpretation and a post-test interview that expanded on participant experiences with the device and instructions-of-use(IFU). Participants were not tested themselves, but provided with contrived results to interpret. RESULTS: The average UI was 92.8%(84.2%-97.6%); the major difficulty was obtaining and transferring the specimen. Participants correctly interpreted 96.1% of the non-reactive/negative, 97.0% of the reactive/positive, 98.0% of the invalid and 79.9% of the weak positive results. Almost all participants(97.0%) stated they would visit a clinic or seek treatment for positive results; with negative results, half(50.6%) stated they should re-test in the next three months while one-third(36.1%) said they should condomize. Nearly all found the devices easy to use(96.6%), the IFUSs easy to understand(97.9%) and felt confident using the test unassisted(95.9%) but suggested improvements to packaging/IFUs to further increase usability; 19.9% preferred clinic-based testing to HIVST. CONCLUSION: The UI and interpretation of results was high and in-line with previous usability studies, suggesting that these kits are appropriate for use in the general, untrained and unsupervised public.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Kit de Reagentes para Diagnóstico , Adulto , Estudos Transversais , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento/instrumentação , Kit de Reagentes para Diagnóstico/virologia , Saliva/microbiologia , África do Sul/epidemiologia , Interface Usuário-Computador , Adulto Jovem
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