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2.
Medicine (Baltimore) ; 98(39): e17105, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574809

RESUMO

We aimed to determine the accuracy and failure of OAK device, an automated screening, for the assessment of fall risk in a prospective cohort of healthy adults aged over 65 years. The algorithm for fall risk assessment of the centers for disease control and prevention (CDC) was used as reference standard. Of the 183 individuals recruited, the CDC algorithm classified 80 as being at moderate/high risk and 103 at low risk of falling. OAK device failure incidence was 4.9% (confidence interval [CI] upper limit 7.7%), below the preset threshold for futility-early termination of the study (i.e., not above 15%). The OAK device showed a sensitivity of 84% and a specificity of 67% (receiver operating characteristic [ROC] area 82%; 95% confidence interval [CI] 76-88%), not reaching the preplanned target sensitivity (not lower than 85%). Diagnostic accuracy was not far from the sensitivity levels similar to those obtained with other fall risk assessment. However, some limitations can be considered.ClinicalTrials.gov identifier: NCT02655796.


Assuntos
Acidentes por Quedas , Teste de Esforço/métodos , Programas de Rastreamento/métodos , Medição de Risco/métodos , Idoso , Desenho de Equipamento , Falha de Equipamento , Teste de Esforço/instrumentação , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
3.
High Blood Press Cardiovasc Prev ; 26(4): 339-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385256

RESUMO

INTRODUCTION: Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. AIM: To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. METHODS: In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. RESULTS: The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). CONCLUSIONS: Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.


Assuntos
Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/instrumentação , Serviços Comunitários de Farmácia , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
4.
Work ; 63(2): 165-180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156198

RESUMO

BACKGROUND: A standard, reliable, objective measure is needed for identifying individuals with mild to moderate traumatic brain injury (TBI). OBJECTIVE: The purpose of this study was to examine balance using an AMTI OR6-7 force platform (FP), neurocognition and mood using the Automated Neuropsychological Assessment Metric4 (ANAM4), blood flow comparisons using a Brain Acoustic Monitor (BAM), and voice using Voice Analysis software (VA) for screening service members for a mild to moderate TBI. METHODS: Active duty and retired service member volunteers (n = 88, 35 with a diagnosis of mild to moderate TBI and 53 who never had a TBI) completed an informed consent document, and evaluations using the four technologies. RESULTS: Development of a clinical prediction rule yielded two FP variables and one ANAM4 Mood Scale variable (vigor) as helpful in predicting the presence of a TBI. Assuming a 15% pre-test probability, these predictors yield a post-test probability of 75.7% for a positive result with any two or more measures being positive, and a post-test probability of 2.3% for a negative result with zero measures being positive. CONCLUSIONS: This study demonstrated the usefulness of a force platform and a self-reported mood scale for predicting presence of mild to moderate TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Programas de Rastreamento/instrumentação , Militares/estatística & dados numéricos , Avaliação da Tecnologia Biomédica/métodos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Análise de Variância , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Militares/psicologia , Testes Neuropsicológicos , Autorrelato , Estados Unidos , Voz/fisiologia
5.
Gynecol Oncol ; 154(2): 360-367, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160073

RESUMO

OBJECTIVES: There is growing interest in using human papillomavirus (HPV) genotyping as a risk-based triage approach for women with atypical squamous cells-undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) cytology. METHODS: This analysis includes 2807 subjects with ASC-US or LSIL cytology, ≥21 years, from the baseline phase of the Onclarity HPV trial. All women were referred to colposcopy/biopsy. Hierarchical-ranked prevalence and risk values, associated with high-grade cervical disease, were calculated based on extended genotyping. RESULTS: HPV 16 carried the highest risk for cervical intraepithelial neoplasia grade 2 or worse (≥CIN2) in both the ASC-US and LSIL populations. Risk of ≥CIN3 and ≥CIN2 associated with the other 13 genotypes varied somewhat for women with ASC-US and LSIL, however, HPV 31, 18, 33/58, 51 and 52 appear to comprise an intermediate risk band. Risk associated with HPV 35/39/68, 45, and 56/59/66, in either cytology population, was relatively low and beneath the benchmark threshold risk for immediate colposcopy. Restricting the analysis to women 21-24 years, ≥25 years, or ≥30 years produced similar results. CONCLUSIONS: HPV genotyping identified multiple risk bands for ≥CIN3 and ≥CIN2 in the ≥21 year-old ASC-US and LSIL populations. These results support a 1-year follow-up period to preclude immediate colposcopy for ASC-US or LSIL women positive for the lowest-risk HPV genotypes.


Assuntos
Células Escamosas Atípicas do Colo do Útero/virologia , Programas de Rastreamento/estatística & dados numéricos , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colposcopia/estatística & dados numéricos , Estudos Transversais , Feminino , Genótipo , Humanos , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/genética , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
6.
JMIR Mhealth Uhealth ; 7(6): e13641, 2019 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-31199337

RESUMO

BACKGROUND: Mobile health (mHealth) devices can be used for the diagnosis of atrial fibrillation. Early diagnosis allows better treatment and prevention of secondary diseases like stroke. Although there are many different mHealth devices to screen for atrial fibrillation, their accuracy varies due to different technological approaches. OBJECTIVE: We aimed to systematically review available studies that assessed the accuracy of mHealth devices in screening for atrial fibrillation. The goal of this review was to provide a comprehensive overview of available technologies, specific characteristics, and accuracy of all relevant studies. METHODS: PubMed and Web of Science databases were searched from January 2014 until January 2019. Our systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. We restricted the search by year of publication, language, noninvasive methods, and focus on diagnosis of atrial fibrillation. Articles not including information about the accuracy of devices were excluded. RESULTS: We found 467 relevant studies. After removing duplicates and excluding ineligible records, 22 studies were included. The accuracy of mHealth devices varied among different technologies, their application settings, and study populations. We described and summarized the eligible studies. CONCLUSIONS: Our systematic review identifies different technologies for screening for atrial fibrillation with mHealth devices. A specific technology's suitability depends on the underlying form of atrial fibrillation to be diagnosed. With the suitable use of mHealth, early diagnosis and treatment of atrial fibrillation are possible. Successful application of mHealth technologies could contribute to significantly reducing the cost of illness of atrial fibrillation.


Assuntos
Fibrilação Atrial/diagnóstico , Programas de Rastreamento/normas , Telemedicina/instrumentação , Telemedicina/normas , Humanos , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Reprodutibilidade dos Testes , Telemedicina/métodos
7.
S Afr Med J ; 109(4): 227-231, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084686

RESUMO

Current research suggests that HIV self-screening (HIVSS) is a feasible and acceptable approach to increase HIV testing among men who have sex with men (MSM). However, few data are available to shape policy around dissemination and implementation. Gaps in knowledge include preferences for distribution of HIVSS kits, potential social harms and benefits of their use, and how much test users would be willing to pay for the kits. The aim was to inform policy recommendations to optimise distribution of HIVSS kits to MSM in South Africa (SA), where there is a high HIV incidence and unmet testing needs. MSM in the high-HIV-prevalence Gert Sibande and Ehlanzeni districts of Mpumalanga Province, SA, were enrolled between October 2015 and May 2017. Participants were provided with their choice of blood or oral fluid HIVSS test kits, receiving 5 kits at enrolment and 4 additional kits at the 3-month follow-up visit. Questionnaires were administered at enrolment, 3 months and 6 months. We analysed participants' reported social benefits and harms, and their preferences for kit distribution and pricing. Among 127 MSM screened and enrolled, 114 responded to follow-up questionnaires regarding distribution preferences, 49.3% preferred to acquire HIVSS kits at a community-based organisation (CBO) and 42.7% at a clinic, with 8% preferring a pharmacy. Participants with higher education preferred CBO sites for distribution; in other respects preferences were similar by demographic characteristics. Reported social benefits were common, including knowing one's status, prevention knowledge gained and improved communication with partners. Despite ubiquitous interest in using the kits, the majority of MSM could not afford to purchase test kits. SA guidelines have integrated HIVSS into HIV and testing policy, but little has been published regarding distribution channels of the kits for MSM and other key populations. There is a partnership between the National Department of Health and CBOs that specialise in key population programming to ensure MSM and other populations with unmet testing needs can access affordable test kits. We observed no social harms, and there were multiple social benefits. Consequently, we recommend immediate free or low-cost distribution of HIVSS kits to MSM through community-based initiatives. Future research should continue to assess optimised linkage to care.


Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Política de Saúde , Homossexualidade Masculina , Programas de Rastreamento , Preferência do Paciente/psicologia , Kit de Reagentes para Diagnóstico , Adolescente , Adulto , Seguimentos , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Acesso aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Preferência do Paciente/economia , Kit de Reagentes para Diagnóstico/economia , Kit de Reagentes para Diagnóstico/provisão & distribução , Autorrelato , África do Sul , Adulto Jovem
8.
Am J Trop Med Hyg ; 100(5): 1290-1293, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30915954

RESUMO

In low- and middle-income countries that have high burdens of disease, simple interventions such as health screenings can have a significant impact on health outcomes. Among vulnerable children, orphans in particular, deaths are often caused by conditions preventable through early identification and provision of basic health and nutritional needs. After consulting local preventative care guidelines and medical providers, a health screening tool for use in orphanages was created. This tool was used to screen children in two orphanages in Lesotho. Overall, the tool was found to be easy, efficient, and valuable in identifying both preventable and immediately treatable conditions in orphans. As a result, orphans with long-term medical needs were linked to community-based providers by developing individualized care plans in collaboration with orphanage colleagues. This preventative tool offers a screening strategy that directly aligns with the United Nations Agency for Development's Sustainable Development Goals and helps to advance the goal of universal health coverage.


Assuntos
Crianças Órfãs , Programas de Rastreamento/instrumentação , Orfanatos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lesoto , Masculino , Programas de Rastreamento/métodos , Medicina Preventiva/instrumentação , Medicina Preventiva/métodos , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde , Adulto Jovem
9.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30894408

RESUMO

BACKGROUND AND OBJECTIVES: Despite professional guidelines to conduct universal early childhood developmental screening, primary care providers often struggle with early identification of developmental delays, referrals to interventions, and connecting families to services. In this study, we tested the efficacy of telephone-based developmental screening and care coordination through 2-1-1 Los Angeles County, which is part of a national network of call centers, compared with usual care alone. METHODS: Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services. After 6 months, primary outcomes included the following: (1) percentage of children referred for developmental evaluation and intervention services and (2) percentage of children actually receiving services. RESULTS: One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone. CONCLUSIONS: Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Intervenção Médica Precoce/organização & administração , Programas de Rastreamento/instrumentação , Planejamento de Assistência ao Paciente/organização & administração , Telefone/estatística & dados numéricos , Instituições de Assistência Ambulatorial , California , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Programas de Rastreamento/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Medição de Risco
10.
World J Gastroenterol ; 25(11): 1378-1386, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30918430

RESUMO

BACKGROUND: Conventionally, the low luminous intensity, low image resolution, and difficulty in operation have been reported with the ultrathin endoscope. However, it has markedly advanced recently. The improvement of the diagnostic ability is expected. AIM: To compare the early gastric cancer diagnostic ability of an ultrathin endoscope loaded with a laser light source and that of the conventional endoscope. METHODS: The target subjects were 375 consecutive patients who underwent endoscopy at our hospital for post-endoscopic submucosal dissection follow-up of gastric cancer from January to August 2018. During endoscopy, the ultrathin endoscope was used in 140 patients (37.3%), and the conventional endoscope was used in 235 patients (62.7%). Patient background was adjusted using the propensity score matching method, and gastric cancer detection ability was evaluated in the two groups. RESULTS: The gastric cancer detection rate was 7.8% in the ultrathin endoscope group and 7.0% in the conventional endoscope group, and the mean intragastric observation time was 4.1 ± 1.7 min in the ultrathin endoscope group and 4.1 ± 1.9 min in the conventional endoscope group, showing no significant differences between the groups. Moreover, the biopsy implementation rate was 31.8% in the ultrathin endoscope group and 41.1% in the conventional endoscope group, and the biopsy prediction rate was 17.9% and 13.2%, respectively, showing no significant differences between the groups. CONCLUSION: The gastric cancer diagnostic ability of the ultrathin endoscope loaded with a laser light source was comparable to that of the conventional endoscope. The observation time was also comparable. Thus, endoscopy using the ultrathin endoscope loaded with the laser light source would be the first option in screening examinations of gastric cancer due to its low invasion.


Assuntos
Detecção Precoce de Câncer/instrumentação , Gastroscópios , Gastroscopia/instrumentação , Programas de Rastreamento/instrumentação , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/instrumentação , Biópsia/métodos , Detecção Precoce de Câncer/métodos , Ressecção Endoscópica de Mucosa , Feminino , Gastroscopia/métodos , Humanos , Lasers , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Estômago/diagnóstico por imagem , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Fatores de Tempo
11.
Mil Med ; 184(Suppl 1): 571-578, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901416

RESUMO

Concussion biomarkers are important guides for diagnosis and return-to-duty decisions. Recent literature describes the King-Devick (KD) test as a sensitive sports-related concussion screener. This test involves timing an individual reading aloud 120 digits printed on three test cards. The test is commonly considered to evaluate the effects of concussion and other factors on reading-related eye movements (EMs). However, the extent to which the KD test reflects EMs remains a matter of conjecture since the test reports only reading speed and number of errors. An off-the-shelf, computerized KD with eye tracking system recently became commercially available. Two early model KD with eye tracking systems were purchased in 2015 and evaluated before deploying them for research. The evaluation consisted of two studies; one with 20 volunteers assessing the comparability of the two systems and the other with 5 volunteers to quantify the systems' stability and repeatability over 5 successive days. The results showed that several of the systems' reported EM response parameters lacked face validity; consequently, the systems could not be used for scientific research. This conclusion emphasizes the importance of systematic test and evaluation of new equipment before it is used for research.


Assuntos
Biomarcadores/análise , Concussão Encefálica/diagnóstico , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Concussão Encefálica/fisiopatologia , Desenho de Equipamento/normas , Movimentos Oculares/fisiologia , Humanos , Testes Neuropsicológicos/normas
12.
Med Hypotheses ; 125: 106-108, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902135

RESUMO

Diabetes mellitus (DM) is a major health care burden associated with significant morbidity and serious impact on the quality of life. Estimating blood glucose levels is the currently employed method for screening for DM. Due to the invasive nature of access to blood glucose; new methods are being suggested that depend upon different targets than blood or another biochemical pathway altogether. But these are not cost effective and have inherent limitations related to public screening. We hypothesize a simple, non invasive and cheap paper strip method to estimate tear film glucose levels for screening purposes at community level. We also discuss the ideal properties of such a paper strip and the process of validation the technique should undergo before being employed for mass usage.


Assuntos
Diabetes Mellitus/diagnóstico , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Lágrimas/química , Glicemia/análise , Análise Custo-Benefício , Humanos , Microfluídica , Papel , Testes Imediatos
13.
JMIR Mhealth Uhealth ; 7(3): e11437, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30835243

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The asymptomatic nature and paroxysmal frequency of AF lead to suboptimal early detection. A novel technology, photoplethysmography (PPG), has been developed for AF screening. However, there has been limited validation of mobile phone and smart band apps with PPG compared to 12-lead electrocardiograms (ECG). OBJECTIVE: We investigated the feasibility and accuracy of a mobile phone and smart band for AF detection using pulse data measured by PPG. METHODS: A total of 112 consecutive inpatients were recruited from the Chinese PLA General Hospital from March 15 to April 1, 2018. Participants were simultaneously tested with mobile phones (HUAWEI Mate 9, HUAWEI Honor 7X), smart bands (HUAWEI Band 2), and 12-lead ECG for 3 minutes. RESULTS: In all, 108 patients (56 with normal sinus rhythm, 52 with persistent AF) were enrolled in the final analysis after excluding four patients with unclear cardiac rhythms. The corresponding sensitivity and specificity of the smart band PPG were 95.36% (95% CI 92.00%-97.40%) and 99.70% (95% CI 98.08%-99.98%), respectively. The positive predictive value of the smart band PPG was 99.63% (95% CI 97.61%-99.98%), the negative predictive value was 96.24% (95% CI 93.50%-97.90%), and the accuracy was 97.72% (95% CI 96.11%-98.70%). Moreover, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mobile phones with PPG for AF detection were over 94%. There was no significant difference after further statistical analysis of the results from the different smart devices compared with the gold-standard ECG (P>.99). CONCLUSIONS: The algorithm based on mobile phones and smart bands with PPG demonstrated good performance in detecting AF and may represent a convenient tool for AF detection in at-risk individuals, allowing widespread screening of AF in the population. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-OOC-17014138; http://www.chictr.org.cn/showproj.aspx?proj=24191 (Archived by WebCite at http://www.webcitation/76WXknvE6).


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia/instrumentação , Fotopletismografia/normas , Adulto , Idoso , Telefone Celular/instrumentação , Telefone Celular/estatística & dados numéricos , Distribuição de Qui-Quadrado , Eletrocardiografia/métodos , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fotopletismografia/instrumentação , Fotopletismografia/métodos , Projetos Piloto , Sensibilidade e Especificidade , Estatísticas não Paramétricas
14.
PLoS One ; 14(2): e0211045, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726252

RESUMO

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.


Assuntos
Telefone Celular , Colposcopia/métodos , Microscopia Intravital/métodos , Displasia do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/prevenção & controle , Brasil , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Colposcopia/economia , Colposcopia/instrumentação , Países em Desenvolvimento , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Células HeLa , Recursos em Saúde/provisão & distribução , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Microscopia Intravital/economia , Microscopia Intravital/instrumentação , Programas de Rastreamento/economia , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Aplicativos Móveis , Exame Físico/economia , Exame Físico/instrumentação , Exame Físico/métodos , Impressão Tridimensional , Sensibilidade e Especificidade , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia
15.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775889

RESUMO

BACKGROUND: Urinalysis based on microbiological culture and manual microscopy requires expertise and is labor intensive. Automated screening could save time and improve patient management in clinical settings. METHODS: We evaluated the fully automated cobas u 701 analyzer for identifying infection-negative urine samples using 2,046 anonymized samples from a routine pathology laboratory. Samples containing ≥ 40 white blood cells (WBC)/µL and/or ≥ 100 bacteria/µL were considered positive. For microbiological cultures: pure growth of ≥ 108 colony-forming units (cfu)/L was considered significant; > 107 cfu/L was considered significant for pregnant women, children < 12 years, immune-compromised/critical care patients or patients with > 100 WBC/µL. RESULTS: The cobas u 701 analyzer identified 1,346 positive samples, giving a 65.7% culture rate. Sensitivity and negative predictive value were high (> 99%). Most replicates were within two standard deviations of the original measurement. CONCLUSIONS: The cobas u 701 analyzer is an effective screening tool for routine urinalysis and demonstrates rapid turnaround times, thus benefiting patients and clinicians.


Assuntos
Infecções Bacterianas/urina , Programas de Rastreamento/métodos , Microscopia/métodos , Urinálise/métodos , Automação , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Carga Bacteriana , Criança , Testes Diagnósticos de Rotina/instrumentação , Testes Diagnósticos de Rotina/métodos , Feminino , Humanos , Contagem de Leucócitos , Programas de Rastreamento/instrumentação , Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Urina/citologia , Urina/microbiologia
16.
Malar J ; 18(1): 17, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670018

RESUMO

BACKGROUND: Transfusion with Plasmodium-infected blood represents a risk for malaria transmission, a rare but severe event. Several non-endemic countries implement a strategy for the screening of candidate blood donors including questionnaire for the identification of at-risk subjects and laboratory testing of blood samples, often serology-based, with temporary deferral from donation for individuals with a positive result. In Italy, the most recent legislation, issued in November 2015, introduced the use of serological tests for the detection of anti-Plasmodium antibodies. METHODS: In the absence of a gold standard for malaria serology, the aim of this work was to evaluate five commercial ELISA kits, and to determine their accuracy (sensitivity and specificity) in comparison to immuno-fluorescence antibody test (IFAT), and their agreement (concordance of results). Serum samples from malaria patients or from subjects with malaria history (N = 64), malaria naïve patients with other parasitic infections (N = 15), malaria naïve blood donors (N = 8) and malaria exposed candidate blood donors (N = 36) were tested. RESULTS: The specificity of all ELISA kits was 100%, while sensitivity ranged between 53 and 64% when compared to IFAT on malaria patients samples. When tested on candidate blood donors' samples, ELISA kits showed highly variable agreement (42-94%) raising the possibility that the same individual could be included or excluded from donation depending on the test in use by the transfusion centre. CONCLUSIONS: These preliminary results indicate how the lack of a gold standard for malaria serology must be taken into account in the application and future revision of current legislation. There is need of developing more sensitive serological assays. Moreover, the adoption of a unique serological test at national level is recommended, as well as the development of screening algorithms based on multiple laboratory tests, including molecular assays.


Assuntos
Doadores de Sangue/estatística & dados numéricos , Ensaio de Imunoadsorção Enzimática/métodos , Malária/diagnóstico , Programas de Rastreamento/métodos , Plasmodium/isolamento & purificação , Ensaio de Imunoadsorção Enzimática/instrumentação , Itália , Malária/parasitologia , Malária/transmissão , Programas de Rastreamento/instrumentação , Estudos Retrospectivos , Sensibilidade e Especificidade
17.
Int Psychogeriatr ; 31(1): 133-138, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29798738

RESUMO

ABSTRACTBackground and Aims:The changes in DSM-5 diagnostic criteria for dementia (Major neurocognitive disorder (NCD)) and mild cognitive impairment (mild NCD) mandate a re-evaluation of screening instruments. This study attempted to validate screening instruments, identify optimum threshold, and describe their indices of efficacy. METHOD: Consecutive people above the age of 65 years attending the outpatient department of a general hospital were recruited. They were assessed using the Mini-Mental State Examination and the Vellore Screening Instruments for Dementia and were evaluated against the DSM-5 standard. Bivariate and multivariate statistics were obtained. Receiver-operating-characteristic curves were drawn, optimum thresholds obtained, sensitivity, specificity, and predictive values calculated. RESULTS: One hundred and thirty four older people were recruited. The majority were women, married, with low levels of education, not employed, living with family, and had medical co-morbidity. A minority satisfied DSM-5 criteria for major (1.5%) and mild NCD (36.5%). The factors associated with NCD were older age, fewer years of education, and lower socio-economic status. MMSE, VSID patient, and VSID informant scores were significantly associated with NCD. The indices of efficacy for the MMSE and VSID patient version were modest for identifying Mild NCD. However, their performance in identifying major NCD was better. Nevertheless, optimal thresholds for recognition differed markedly from their originally recommended cut-offs. CONCLUSIONS: The DSM-5 standards, with new and different cognitive domains, mandate a revaluation and recalibration of existing screening instruments. Ideally, new screening instruments, which match the cognitive domains and DSM-5 standard should be developed.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Gerais , Humanos , Índia , Modelos Lineares , Modelos Logísticos , Masculino , Testes de Estado Mental e Demência , Curva ROC , Sensibilidade e Especificidade
18.
Patient Educ Couns ; 102(4): 749-752, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30503639

RESUMO

OBJECTIVE: To determine the reliability of the Newest Vital Sign (NVS) administered via telephone by examining test-retest properties of the measure. METHODS: Data were obtained from a randomized controlled trial promoting opioid safe use. Participants were 18 or older and English-speaking. NVS assessment occurred in-person at baseline and in-person or via telephone at follow-up. Intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability using raw NVS scores by mode of administration of the second NVS assessment. Kappa statistics were used to examine test-retest agreement based on categorized NVS score. Internal consistency was measured with Cronbach's alpha. RESULTS: Data from 216 patients (70 completing follow-up in-person and 146 via telephone) were included. Reliability was high (ICCs: in-person = 0.81, phone = 0.70). Agreement was lower for three category NVS score (Kappas: in-person = 0.58, 95% CI [0.39-0.77]; phone = 0.52, 95% CI [0.39-0.65]) compared to two category NVS (Kappas: in-person = 0.65, 95% CI [0.46-0.85]; phone = 0.64, 95% CI [0.51-0.78]). Correlations decreased as time between administrations increased. Internal consistency was moderately high (baseline NVS in-person (α = 0.76), follow-up NVS in-person (α = 0.76), and phone follow-up (α = 0.78). CONCLUSION: The test-retest properties of the NVS are similar by mode of administration. PRACTICE IMPLICATIONS: This data suggests the NVS measure is reliably administered by telephone.


Assuntos
Alfabetização em Saúde/normas , Programas de Rastreamento/instrumentação , Psicometria/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Telefone
19.
J Acquir Immune Defic Syndr ; 80(2): 135-144, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30422908

RESUMO

BACKGROUND: In several subgroups of South Africa, the percentage of HIV-positive individuals aware of their status falls well below the UNAIDS 90% target. This study examined the impact that home-based HIV testing services (HBHTS) had on knowledge of status in a hyperendemic area of South Africa. METHODS: We analysed data from the second cross-sectional HIV Incidence Provincial Surveillance System survey (2015/2016), a representative sample (n = 10,236) of individuals aged 15-49 years. Participants completed a questionnaire, provided blood samples for laboratory testing (used to estimate HIV prevalence), and were offered HBHTS. The proportion of people living with HIV (n = 3870) made aware of their status through HBHTS was measured, and factors associated with HBHTS uptake were identified. RESULTS: Knowledge of HIV-positive status at the time of the survey was 62.9% among men and 73.4% among women. Through HBHTS, the percentage of HIV-positive men and women who knew their status rose to 74.2% and 80.5%, respectively. The largest impact was observed among youth (15-24 years). Knowledge of status increased from 36.6% to 59.3% and from 50.8% to 64.8% among young men and women, respectively. In addition, 51.4% of those who had previously never tested received their first test. Key reasons for declining HBHTS among undiagnosed HIV-positive individuals included fear and self-report of an HIV-negative status. CONCLUSIONS: HBHTS was effective in increasing awareness of HIV-positive status, particularly among youth, men, and those who had never tested. HBHTS could have a marked impact on progress toward the UNAIDS 90-90-90 targets within these subgroups.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/diagnóstico , Programas de Rastreamento/instrumentação , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Nações Unidas , Adolescente , Adulto , Fármacos Anti-HIV , Estudos Transversais , Assistência à Saúde , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , África do Sul/epidemiologia , Adulto Jovem
20.
Am J Clin Pathol ; 151(4): 377-385, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423023

RESUMO

OBJECTIVES: We evaluated the performance of the Elecsys HIV combi PT assay on the cobas e 602 analyzer for diagnosing human immunodeficiency virus (HIV; part of the US Food and Drug Administration [FDA] submission). METHODS: The HIV combi PT and reference (ARCHITECT HIV Ag/Ab Combo) assays were assessed at four independent clinical laboratories/one reference laboratory (United States; July 2014 to November 2015). Clinical performance was evaluated using four reagent lots. Analytical performance was evaluated per Clinical and Laboratory Standards Institute EP05-A3 guidelines. Serum/plasma samples from 18 clinical sites/vendors (United States and outside the United States) were tested. RESULTS: Sensitivity (95% confidence interval [CI]) in HIV-1 antibody-positive individuals (United States and outside the United States; n = 1,460) was 100.00% (99.75%-100.00%). Specificity was 99.94% (95% CI, 99.85%-99.98%) in low-risk individuals (United States; n = 6,843), 98.19% (95% CI, 96.93%-99.04%) in high-risk individuals (United States and outside the United States; n = 758), and 97.43% (95% CI, 95.32%-98.76%) in pregnant women (United States and outside the United States; n = 440). Analytical performance was acceptable. CONCLUSIONS: We demonstrate the robustness of the FDA-approved Elecsys HIV combi PT assay on the cobas e 602 analyzer for HIV testing in the United States.


Assuntos
Anticorpos Anti-HIV/sangue , Infecções por HIV/diagnóstico , HIV-1/imunologia , Grupos Diagnósticos Relacionados , Feminino , Infecções por HIV/sangue , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , Tempo de Internação , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Gravidez , Tempo de Protrombina , Sensibilidade e Especificidade , Estados Unidos
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