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Melo WSD, Brito LCDS, Oliveira BLCAD, Barbosa LP, Cardoso MVLML. Prevalence of neonatal screening and associated factors in Brazil: a comparison of the 2013 and 2019 National Health Surveys. CIENCIA & SAUDE COLETIVA 2024; 29:e10482023. [PMID: 38896676 DOI: 10.1590/1413-81232024296.10482023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/21/2023] [Indexed: 06/21/2024] Open
Abstract
This study analyzed the prevalence of complete neonatal screening (CNS) of children aged under 2 years in Brazil and associated factors using data from the 2013 (n=4,442) and 2019 (n=5,643) national health surveys. We conducted a cross-sectional study to compare prevalence of CNS (eye, ear and heel prick tests) adopting 95% confidence intervals (95%CI) and a 5% significance level. Crude and adjusted Poisson regression was performed to estimate prevalence ratios (PR) and 95%CI to assess the association between socioeconomic, demographic and health variables and CNS. There was a statistically significant increase in CNS prevalence, from 49.2% (95%CI: 47.1-51.3) in 2013 to 67.4% (95%CI: 65.5-69.3) in 2019. However, large disparities persist across states and between sociodemographic groups. In both years, CNS prevalence was lowest among brown and black children, those from families in the three lowest income quintiles, children without health insurance, those from families registered in the Family Health Strategy and children living in the North, cities outside the state capital/metropolitan regions and rural areas. Despite the increase in prevalence of CNS, deep individual and contextual inequalities persist, posing challenges for health policies.
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Affiliation(s)
- Wesley Soares de Melo
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Ceará (UFC). R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | - Leandro Cardozo Dos Santos Brito
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Ceará (UFC). R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | | | - Lorena Pinheiro Barbosa
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Ceará (UFC). R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Dias LR, Tomasi YT, Boing AF. The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019. J Pediatr (Rio J) 2024; 100:296-304. [PMID: 38169234 PMCID: PMC11065651 DOI: 10.1016/j.jped.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.
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Affiliation(s)
- Letícia R Dias
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Florianópolis, SC, Brazil.
| | - Yaná T Tomasi
- Universidade do Estado de Santa Catarina (UDESC), Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Antonio F Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
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Costa JLD, Montagner MI, Montagner MÂ, Alves SMC, Delduque MC. Experiences and strategies of people with sickle cell disease in the Federal District: the biographical rupture. CIENCIA & SAUDE COLETIVA 2024; 29:e11782023. [PMID: 38451654 DOI: 10.1590/1413-81232024293.11782023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
This is a study on sickle cell disease, a chronic illness that affects many Brazilians, that aims to understand and analyze how people address the adversities arising from the diagnosis and the biographical rupture. The description of people's experiences and strategies conjures a picture that expresses the respondents' habitus, built in a dialectical relationship with the vulnerability determined by the disease. We adopted a qualitative approach and focused interviews as proposed by Merton, combined with the snowball technique, applied to groups related to sickle cell disease on social networks. Seven participants were selected because they were privileged informants with the disease, were over eighteen, lived in the Federal District, and were non-exclusive users of the Unified Health System. The interview material was categorized from the focal groups employed. The results indicated the following categories: biographical rupture, experience and coping strategies, and healthcare. It is necessary to sensitize professionals and the population about the challenging living conditions of people with sickle cell disease and the consolidation of public policies and care networks to accommodate this population.
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Affiliation(s)
- Jéssica Luciano da Costa
- Faculdade de Ceilândia, Universidade de Brasília. Campus Universitário, Centro Metropolitano, Ceilândia Sul. 72220-275 Brasília DF Brasil.
| | - Maria Inez Montagner
- Faculdade de Ceilândia, Universidade de Brasília. Campus Universitário, Centro Metropolitano, Ceilândia Sul. 72220-275 Brasília DF Brasil.
| | | | | | - Maria Célia Delduque
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Brasília. Brasília DF Brasil
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Costa RD, Ferreira MDFDC, Rocha TDA, Galera MF. Evaluation of newborn screening in the state of Mato Grosso from 2005 to 2019. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022161. [PMID: 37646746 PMCID: PMC10503421 DOI: 10.1590/1984-0462/2024/42/2022161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/07/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To evaluate quality indicators of the Neonatal Screening Referral Service of the state of Mato Grosso (NSRS-MT) from 2005 to 2019. METHODS Cross-sectional, retrospective, exploratory, descriptive, and observational study from 2005 to 2019. The following parameters were analyzed: age of newborns at the first collection, time between sample collection and arrival at the laboratory, time between the arrival and release of results and time between requesting the second sample and arrival at the NSRS. The population coverage of the program and the incidence of each clinical situation screened were also analyzed. RESULTS NSRS-MT coverage was analyzed and recorded as 76%. The incidence was analyzed for congenital hypothyroidism (CH) 1:1867, phenylketonuria (PKU) 1:33,311, sickle cell disease (SCD) 1:2004, cystic fibrosis (CF) 1:12,663, congenital adrenal hyperplasia (CAH) 1:15,843, and biotinidase deficiency (DB) 1:25,349. The median age (days) at the first consultation was: 44 for HC, 22 for PKU, 60 for DF, 52 for FC, 79 for HAC and 79 for DB. The mean time between exam collection and delivery to the NSRS was 8.4 days; between the arrival and release of results, 9 days; and for the return of recalls, 59 days. CONCLUSIONS Regarding the coverage of the target population and collection at the ideal age, the NSRS-MT presents values below the national average. However, regarding the mean age at the time of the first consultation, the state's performance is better than the national.
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Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil. J Pediatr (Rio J) 2023; 99:23-30. [PMID: 35679883 PMCID: PMC9875232 DOI: 10.1016/j.jped.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. METHOD A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. RESULTS The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. CONCLUSIONS The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
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Botelho JBL, de Carvalho DM, dos Santos-Melo GZ, Cardoso J, do Nascimento SM, de Figueiredo WLD, Lacerda LA, Nogueira KH. Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus. Rev Saude Publica 2022; 56:120. [PMID: 36629711 PMCID: PMC9749742 DOI: 10.11606/s1518-8787.2022056004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/18/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss. METHODS Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson's chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%. RESULTS Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay. CONCLUSION Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.
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Affiliation(s)
- João Bosco Lopes Botelho
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Diego Monteiro de Carvalho
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Giane Zupellari dos Santos-Melo
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - José Cardoso
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Samuel Machado do Nascimento
- Centro Universitário FametroFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Centro Universitário Fametro. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Wenberger Lanza Daniel de Figueiredo
- Universidade Nilton LinsFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade Nilton Lins. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Larissa Abreu Lacerda
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
| | - Kristian Holanda Nogueira
- Universidade do Estado do AmazonasFaculdade de MedicinaDepartamento de MedicinaManausAmazonasBrasil Universidade do Estado do Amazonas. Faculdade de Medicina. Departamento de Medicina. Manaus, Amazonas, Brasil
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Pinheiro JMF, Costa KTDS, Lyra CDO, dos Santos FAPS, Vianna RPDT, Silva KDL, de Andrade FB. Care actions for newborns and factors associated with longitudinality in the follow-up care in the neonatal period: Care actions for the newborn. Medicine (Baltimore) 2022; 101:e31500. [PMID: 36397371 PMCID: PMC9666128 DOI: 10.1097/md.0000000000031500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
As newborns are highly vulnerable, they require essential care for adequate child development. This study aimed to assess the care provided to newborns during the first 28 days of life and identify factors associated with adequate care. This was a longitudinal study conducted with 415 mothers and full-term newborns from 4 public maternity hospitals in Natal, Brazil, in 2019. Assistance, socioeconomic, and demographic data were collected 3 times: 48 hours, 7 days, and 28 days after birth. Pearson's chi-square and Poisson regression tests were used with a confidence interval of 95%. Most mothers were between 20 and 29 years old (46.5%), had a high school or higher education (65.3%), a partner (79%), an income of ≤ 1 minimum wage (64, 6%), and were multiparous (62.9%). A total of 29 actions performed in maternity hospitals and 11 in primary healthcare were evaluated. Among the first, 8 (27.6%) were satisfactory; 11 (37.9%), partially satisfactory; and 10 (34.5%), unsatisfactory. In primary care, 2 actions (18.2%) were considered satisfactory; 3 (27.3%) partially satisfactory; and 6 (54.5%) unsatisfactory. In the multivariate analysis of the composite indicators related to adequacy of care, women undergoing vaginal delivery, those who are multiparous, and maternity hospitals at usual risk were associated with better adequacy of care indicators (P ≤ .05). Maternity hospitals accredited to the Baby-Friendly Hospital Initiative had lower chances of the adequacy of promotion to exclusive breastfeeding. The sample loss rate was 13.7% in the first week and 16.6% at the end of the study period. There was inadequacy in the performance of care actions for newborns regarding access and comprehensiveness of care. These weaknesses highlight the need for reassessing skills and coordinating actions in the child's healthcare network.
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Affiliation(s)
| | - Ketyllem Tayanne da Silva Costa
- Departamento de Enfermagem, Federal University of Rio Grande do Norte, Brazil
- *Correspondence: Ketyllem Tayanne da Silva Costa, Federal University of Rio Grande do Norte, Departamento de Enfermagem. Salgado Filho Avenue, Natal, Rio Grande do Norte 59075-000, Brazil (e-mail: )
| | - Clelia de Oliveira Lyra
- Doctor in Health Sciences. Professor of the Federal University of Rio Grande do Norte; Natal, Rio Grande do Norte, Brazil
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Dutra MRP, Cavalcanti HG, Ferreira MÂF. Neonatal hearing screening programs: quality indicators and access to health services. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200030009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract Objectives: to verify the quality indicators of neonatal hearing screening programs, identify the most prevalent risk factors for hearing loss and analyze access to the Hearing Health Care Network. Methods: cross-sectional study using secondary data. The population are children born in public maternity hospitals from 2015 to 2019. Data collection was carried out in the database of programs and hearing health service. The absolute and relative frequencies of all variables collected and the median, the interquartile range and the Mann-Whitney test were calculated to analyze the access. Results: universality increased during the study period, but was not reached (71.9%; CI95%=70.4-73.3) and the referral rate for auditory diagnosis was within the recommended range (0.9%; CI95%=0.8-0.9). The most prevalent risk factors were congenital infections and heredity. There was an evasion of children to the hearing health service of 85.1% and the type of referral interfered with the age of the child at access. Eight children with hearing loss were diagnosed, in which seven had access to therapeutic interventions. Conclusions: hearing screening was not universal. Access to the Hearing Health Care Network presents high evasion and interventions were offered to children with hearing loss.
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Epidemiology of rare diseases in Brazil: protocol of the Brazilian Rare Diseases Network (RARAS-BRDN). Orphanet J Rare Dis 2022; 17:84. [PMID: 35209917 PMCID: PMC8867447 DOI: 10.1186/s13023-022-02254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/13/2022] [Indexed: 11/18/2022] Open
Abstract
The Brazilian Policy of Comprehensive Care for People with Rare Diseases (BPCCPRD) was established by the Ministry of Health to reduce morbidity and mortality and improve the quality of life of people with rare diseases (RD). Several laboratory tests, most using molecular genetic technologies, have been incorporated by the Brazilian Public Health System, and 18 specialised centres have so far been established at university hospitals (UH) in the capitals of the Southern, Southeastern and Northeastern regions. However, whether the available human and technological resources in these services are appropriate and sufficient to achieve the goals of care established by the BPCCPRD is unknown. Despite great advances in diagnosis, especially due to new technologies and the recent structuring of clinical assessment of RD in Brazil, epidemiological data are lacking and when available, restricted to specific disorders. This position paper summarises the performance of a nationally representative survey on epidemiology, clinical status, and diagnostic and therapeutic resources employed for individuals with genetic and non-genetic RD in Brazil. The Brazilian Rare Disease Network (BRDN) is under development, comprising 40 institutions, including 18 UH, 17 Rare Diseases Reference Services and five Newborn Screening Reference Services. A retrospective study will be initially conducted, followed by a prospective study. The data collection instrument will use a standard protocol with sociodemographic data and clinical and diagnostic aspects according to international ontology. This great collaborative network is the first initiative of a large epidemiological data collection of RD in Latin America, and the results will increase the knowledge of RD in Brazil and help health managers to improve national public policy on RD in Brazil.
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Mota FM, Ferreira Júnior MA, Cardoso AIDQ, Pompeo CM, Frota OP, Tsuha DH, Souza ASD. Analysis of the temporal trend of mortality from sickle cell anemia in Brazil. Rev Bras Enferm 2022; 75:e20210640. [DOI: 10.1590/0034-7167-2021-0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: To analyze the temporal trend of mortality from sickle cell anemia in Brazil, by region, in the period 1997-2017. Methods: epidemiological study, with an ecological design, with a temporal trend, carried out with data from the Mortality Information System. For descriptive analysis, absolute and relative frequencies were used. In the correlation analysis, the ANOVA test was used, followed by Tukey’s post-test. The temporal trend was obtained using the cubic polynomial regression test. Results: 6,813 deaths from sickle cell anemia were registered. Brown individuals (50.87%) were more frequent, with a predominance of males (50.4%), aged between 25 and 34 years and a higher incidence of deaths in the Midwest (0.25/100 thousand inhabitants). The time curve showed an increasing trend of deaths in the country between 1997 and 2015 (R2 = 0.98). Conclusions: sickle cell anemia showed increasing mortality in the 21 years analyzed and alerts health professionals and managers.
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Melo-Ferreira VD, Junger WL, Werneck GL. [Contextual and individual determinants of use of newborn hearing screening: the Brazilian National Health Survey, 2013]. CAD SAUDE PUBLICA 2021; 37:e00291920. [PMID: 34816960 DOI: 10.1590/0102-311x00291920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
The current study assessed the effect of contextual and individual determinants of the use of newborn hearing screening in Brazilian state capitals and the Federal District. The conceptual theoretical model proposed by Andersen & Davidson (2014) oriented the analyses using multilevel logistic modeling with data from the Brazilian National Health Survey, 2013. The study population (n = 585) is representative of 230,112 pairs of women/responsible person over 18 years of age and their respective children under 2 years of age. At the contextual level (state capitals and Federal District), the use of newborn hearing screening was determined by the proportion of extremely poor individuals (odds ratio - OR = 0.91; 95% confidence interval - 95%CI: 0.83-0.99) and by monthly coverage of newborn hearing screening (OR = 1.02; 95%CI: 1.01-1.02). At the individual level, use of newborn hearing screening was higher in the maternal age bracket 25 to 39 years, compared to < 25 years. The odds of use of newborn hearing screening were lower in mothers with brown race/color (OR = 0.47; 95%CI: 0.26-0.83) compared to white mothers. As for schooling, complete university education nearly tripled the odds of newborn hearing screening when compared to primary schooling (OR = 2.99; 95%CI: 1.15-7.79). Predominantly private prenatal care increased the odds of using newborn hearing screening by 2.18 times, compared to public prenatal care (OR = 2.18; 95%CI: 1.02-4.64). Effective enforcement of existing hearing health laws and policies and prioritization of primary healthcare and health education practices with a focus on more vulnerable newborns, based on the characteristics identified in this study, are initiatives that can help ensure an equitable social protection system.
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Affiliation(s)
| | - Washington Leite Junger
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Pinheiro JMF, Flor TBM, Marinho CDSR, Pires VCDC, de Oliveira LIC, Bezerra MRDO, Clementino JR, de Andrade FB. Prevalence of the five newborn screening tests. PLoS One 2021; 16:e0257282. [PMID: 34516590 PMCID: PMC8437298 DOI: 10.1371/journal.pone.0257282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
Neonatal screening is essential for child health and has the following purposes: (1) pulse oximetry screening to evaluate congenital heart diseases; (2) red reflex examination to investigate eye diseases; (3) newborn hearing screening test to evaluate congenital hearing diseases; (4) tongue test to evaluate the lingual frenulum and identify communication and feeding problems; (5) the Guthrie test to screen for metabolic diseases. This study investigated the prevalence of the five neonatal screening tests and its associated institutional and socio-cultural factors using a cross-sectional study with 415 mother and baby binomials from public maternity hospitals in Natal, RN, Brazil in 2019. Pearson's chi-squared, Mann-Whitney and Poisson regression tests were used, with a significance of p ≤ 0.05 and a 95% confidence interval. The sample loss was 71 mothers (17%). The prevalence in the first week and at the end of 28 days was 93% and 99.5% (pulse oximetry screening), 60% and 97.6% (red reflex examination), 71.9% and 93.6% (Guthrie test), 35.5% and 68.2% (hearing screening test), and 19% and 48.9% (tongue test). Only 152 newborns (36.6%) underwent all five tests. The performance of the tests was associated in the final model (p ≤ 0.05) with the residence of the mothers in the state capital (PR = 1.36; 95% CI = 1.18-1.56) and the provision of guidance for mothers about the five tests in maternity hospitals (PR = 1.30; 95% CI = 1.08-1.67). None of the tests met full coverage, and regional inequities were identified indicating the need to restructure the institutions, training and qualification procedures to improve of the work processes and longitudinal care.
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Affiliation(s)
| | - Taiana Brito Menêzes Flor
- Graduate Degree in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Vanessa Cristina da Costa Pires
- Undergraduate Student from the Nutrition Course, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | | | | | - Fábia Barbosa de Andrade
- Graduate Degree in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Oliveira TDS, Dutra MRP, Cavalcanti HG. Newborn Hearing Screening: association between coverage, and the availability of speech therapists and equipment in Brazil. Codas 2021; 33:e20190259. [PMID: 33978104 DOI: 10.1590/2317-1782/20202019259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/26/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the coverage of newborn hearing screening (NHS) and its association with the availability of speech therapists in the National Health System (SUS) and equipment in the states of Brazil in 2012 and 2018. METHODS This is a descriptive ecological time series study with the Brazilian states and live births as units of analysis. An exploratory analysis of newborn hearing screening coverage and descriptive data analysis were performed. Spearman's correlation coefficient was used to measure the strength and direction of the association between two ranked variables. RESULTS Coverage in Brazil increased from 24.1% to 67.6%. Better coverage was observed in the South and Southeast regions in 2012, and in the former and Mato Grosso state (MS) in 2018. The average number of speech therapists was 4.79 and 8.9 / 100,000 inhabitants in 2012 and 2018, respectively. The index of "transient evoked otoacoustic emission" equipment was below 1 / 100,000 inhabitants in the two years in all the states of the country. CONCLUSION Screening coverage increased in Brazil, albeit below the recommended level, and is related to rising number of speech therapists in the SUS. Spatial distribution is heterogeneous throughout the country.
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Affiliation(s)
- Thalita da Silva Oliveira
- Programa Associado de Pós-graduação em Fonoaudiologia - PPGFON, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | - Monique Ramos Paschoal Dutra
- Programa de Pós-graduação em Saúde Coletiva - PPGSCOL, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
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Santo AH, Silva-Filho LVRFD. Cystic fibrosis-related mortality trends in Brazil for the 1999-2017 period: a multiple-cause-of-death study. J Bras Pneumol 2021; 47:e20200166. [PMID: 33656158 PMCID: PMC8332834 DOI: 10.36416/1806-3756/e20200166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/13/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To describe causes of death and mortality data related to cystic fibrosis (CF) using a multiple-cause-of-death methodology. METHODS Annual mortality data for the 1999-2017 period were extracted from the Brazilian National Ministry of Health Mortality Database. All death certificates in which category E84 (CF) of the ICD-10, was listed as an underlying or associated cause of death were selected. Epidemiological and clinical data were described, and standardized mortality rates were calculated per year and for the 2000-2017 period. A joinpoint regression analysis was performed to detect changes in the mortality rates during the study period. RESULTS Overall, 2,854 CF-related deaths were identified during the study period, ranging from 68 in 1999 to 289 in 2017. CF was the underlying cause of death in 83.5% of the death certificates. A continuous upward trend in the death rates was observed, with a significant annual percent change of 6.84% (5.3-8.4%) among males and 7.50% (6.6-8.4%) among females. The median age at death increased from 7.5 years in 1999 to 56.5 years in 2017. Diseases of the respiratory system accounted for 77% of the associated causes in the death certificates that reported CF as the underlying cause of death. CONCLUSIONS A significant and continuous increase in CF-related death rates was found in Brazil in the last years, as well as a concurrent increase in the median age at death.
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Affiliation(s)
- Augusto Hasiak Santo
- . Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo (SP) Brasil (aposentado)
| | - Luiz Vicente Ribeiro Ferreira da Silva-Filho
- . Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
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Sadigurschi G, Vaz Micherino B, Assunção Mendes da Cunha MB, Antão Paiva CL, da Silva E Sá GR. Analysis of national coverage of neonatal cystic fibrosis screening in Brazil from 2008 to 2017. J Matern Fetal Neonatal Med 2021; 35:5204-5209. [PMID: 33491525 DOI: 10.1080/14767058.2021.1875443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Brazilian neonatal screening program established in 2001 included the investigation of cystic fibrosis (CF) in the phase III of the program. For this purpose, the immunoreactive trypsin (IRT) measurement was added to the newborn screening test. The purpose of National Neonatal Screening Program is to reach 100% of live births in Brazil. The aim of this study was to analyze the coverage of neonatal Screening for Cystic Fibrosis (CF) in Brazil from 2008 to 2017. MATERIALS AND METHODS This is an ecological study design based on data collected from the Brazilian Outpatient Information System regarding the detection of IRT as a component of the heel stick test from 2008 to 2017. Moreover, we gathered data from the Brazilian Live Birth Information System referring to live births from 2008 to 2017. We calculated the coverage of IRT measurement for every 100 live births, using the number of IRT measurement procedures as the numerator and the number of live births stratified by federative units (states), as well as by the Brazilian regions as the denominator. These regions correspond to the divisions of the national territory based on criteria such as natural, social, cultural and economic aspects. RESULTS From 2008 to 2017, the regions presented the following coverage medians: South (84.1%), Southeast (71.4%), Midwest (47.3%) Northeast (12.3%) and North (10.9%). In the analysis of federative units, in the years 2013 to 2017, Paraná and Distrito Federal presented the highest median of coverage (100%), while the states with the lowest median were Rio Grande do Norte (12.1%), Amazonas (16.8%) and Paraíba (27.5%). Highest coverage was found in the South region, where are located most of the states with high socioeconomic development and high supply of health services, while the lowest coverage was found in the North region, where are located manly the states with low socioeconomic development and low supply of health services. According to data from the Brazilian Ministry of Health, the universalization of neonatal screening for cystic fibrosis occurred in 2013, however, at the end of this year, most states in the North and Northeast regions had not registered IRT measurements in the Outpatient Information System. CONCLUSION Although the coverage of neonatal screening for CF has improved nationwide over the years of the study, the disparity in the coverage of IRT measurements at the interregional and interstate levels is notable. Systematic implementation of neonatal screening for cystic fibrosis with equity and access to the entire population is suggested, leading to a greater number of children benefiting from treatment and a better quality of life.
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Affiliation(s)
- Gabriela Sadigurschi
- Escola de Medicina e Cirurgia do Rio de Janeiro, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Vaz Micherino
- Escola de Medicina e Cirurgia do Rio de Janeiro, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carmen Lucia Antão Paiva
- Programa de Pós Graduação em Biologia Molecular e Celular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Tsimpida D, Kontopantelis E, Ashcroft DM, Panagioti M. Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis. Trends Hear 2021; 25:23312165211002963. [PMID: 34049470 PMCID: PMC8165532 DOI: 10.1177/23312165211002963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/29/2020] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people's quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people's health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual's life span; tackling socioeconomic inequalities throughout the life-course could improve the population's health, maximizing the opportunity for healthy aging.
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Affiliation(s)
- Dialechti Tsimpida
- Centre for Primary Care and Health Services Research, Institute for Health Policy and Organisation (IHPO), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Institute for Health Policy and Organisation (IHPO), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Subhi Y, Schmidt DC, Al-Bakri M, Bach-Holm D, Kessel L. Diagnostic Test Accuracy of the Red Reflex Test for Ocular Pathology in Infants: A Meta-analysis. JAMA Ophthalmol 2021; 139:33-40. [PMID: 33180103 PMCID: PMC7662495 DOI: 10.1001/jamaophthalmol.2020.4854] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022]
Abstract
Importance Red reflex testing is a simple and inexpensive method implemented in many countries as an important part of infant screening for ocular pathologies. Objectives To review the literature on the diagnostic accuracy of the red reflex test in infant screening for ocular pathologies and to perform meta-analyses to provide summary estimates. Data Sources The following literature databases were searched for English-language, peer-reviewed literature, published until April 19, 2020: Cochrane Central, PubMed/MEDLINE, Embase, Web of Science Core Collection, BIOSIS Previews, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI-Korean Journal Database, Russian Science Citation Index, SciELO Citation Index, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov. Study Selection Eligibility criteria were defined according to population (studies of consecutively screened infants), exposure (red reflex or Brückner test as the index test), comparator (any ophthalmological examination), and study type (any study with diagnostic test accuracy data). Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were followed. Data were extracted independently by 2 authors. For summary estimates of diagnostic test accuracy, the hierarchical summary receiver operating characteristics curve was used. Prevalence of ocular pathologies was introduced for a prevalence meta-analysis, which was then used in calculations of diagnostic accuracy of the red reflex test when applied in infant screening. Main Outcomes and Measures True-positive, false-positive, true-negative, and false-negative findings; sensitivity; specificity; and positive and negative predictive values. Results In this meta-analysis, 8713 unique infants from 5 unique studies were eligible for qualitative and quantitative review. All studies used the red reflex test without pupillary dilation and were compared with a reference test performed with pupillary dilation. For any ocular pathology, an estimated sensitivity of 7.5% (95% CI, 7.4%-7.5%) and specificity of 97.5% (95% CI, 97.5%-97.5%) was found. Focusing on ocular pathologies that required a medical or surgical intervention, sensitivity improved to 17.5% (95% CI, 0.8%-84.8%) and specificity remained high at 97.6% (95% CI, 87.7%-99.6%). Conclusions and Relevance These findings suggest that an abnormal red reflex finding most likely reflects an underlying ocular pathology. However, a normal red reflex finding during screening does not exclude ocular disease.
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Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | | | - Moug Al-Bakri
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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