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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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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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Nascimento ML, Nascimento AL, Dornbusch P, Ohira M, Simoni G, Cechinel E, Linhares RMM, van De Sande Lee J, Silva PCA. Impact of the reduction in TSH cutoff level to 6 mIU/L in neonatal screening for congenital hypothyroidism in Santa Catarina: final results. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:816-823. [PMID: 33085992 PMCID: PMC10528607 DOI: 10.20945/2359-3997000000299] [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: 07/12/2019] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the implications of changing the cutoff level of TSH from 10 to 6 mIU/L. METHODS The study population was constituted by 74.123 children screened for congenital hypothyroidism by the National Screening Program in Santa Catarina, from March 2011 to February 2012. The cutoff of TSH was 6 mIU/L. If TSH between 6-10 mIU/L, the newborn was recalled for a second TSH measurement on filter paper. If TSH > 6 mIU/L in the second sample, the child was sent for medical evaluation. In children with normal topic thyroid, levothyroxine was suspended for 1 month at the age of 3 years for identification of the etiology and evaluation of the need to continue treatment. RESULTS Among the children screened, 435 were recalled for presenting TSH between 6 and 10 mIU/L in the first sample, 28 remained TSH > 6 mIU/L in the second sample. Among these, 11 had a final diagnosis of dyshormonogenesis, two of ectopic thyroid, two of thyroid hypoplasia and one of transient hypothyroidism. Ten children presented normal TSH levels on the first medical evaluation and two lost follow-up. CONCLUSION A decrease in the TSH cutoff level from 10 to 6 mIU/L in a neonatal screening program for congenital hypothyroidism reduced the number of false-negative results, increasing the sensitivity of the test, but increased the number of false-positive results and recalls. Since a TSH cutoff level of 6 mIU/L detects thyroid function abnormalities requiring treatment, the adoption of this cutoff level is justified.
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Affiliation(s)
- Marilza Leal Nascimento
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil,
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | | | - Patricia Dornbusch
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Masanao Ohira
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Genoir Simoni
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Edson Cechinel
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil
| | - Rose Marie Mueller Linhares
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Juliana van De Sande Lee
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil
| | - Paulo Cesar Alves Silva
- Hospital Infantil Joana de Gusmão, Departamento de Endocrinologia Pediátrica, Florianópolis, SC, Brasil
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Brito LNS, de Andrade CLO, Alves CDAD. ADHESION TO TREATMENT BY CHILDREN WITH CONGENITAL HYPOTHYROIDISM: KNOWLEDGE OF CAREGIVERS IN BAHIA STATE, BRAZIL. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2021; 39:e2020074. [PMID: 33825794 PMCID: PMC8023976 DOI: 10.1590/1984-0462/2021/39/2020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate knowledge of caregivers of children with congenital hypothyroidism (CH), followed in a public reference service, as well as their associations with treatment adherence. METHODS Exploratory, descriptive, cross-sectional study with convenience sample. Medical records of 158 patients diagnosed with congenital hypothyroidism were analyzed, and data were evaluated by applying a previously prepared questionnaire to caregivers from 2014 to 2016. Statistical analysis used the chi-square and the Spearman's correlation tests, being significant p-value ≤0.05. RESULTS Females were predominant among caregivers (94.3%), with a mean age of 31 years, from inland cities (77.8%). There was a predominance of socioeconomic class C (59.5%) and incomplete primary education (35.7%). More than half of patients (53.2%) with CH had an adequate hormonal control. Approximately one third of caregivers had poor knowledge (37.3%) or was unaware (24.1%) about the meaning of congenital hypothyroidism. The low knowledge level of the disease was observed to be related to caregivers' educational level (p=0.004). CONCLUSIONS Lack of education of caregivers was a barrier to be faced when monitoring children with CH. This reality requires greater attention from health professionals to ensure that they use clear language when giving instructions to caregivers, and that caregivers have adequately understood the proposed recommendations.
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Mallmann MB, Tomasi YT, Boing AF. Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities. J Pediatr (Rio J) 2020; 96:487-494. [PMID: 31009617 PMCID: PMC9432296 DOI: 10.1016/j.jped.2019.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/20/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify the prevalence and associated factors with the performance of the Guthrie test, hearing, and red reflex screening tests in Brazil. METHODS This was a population-based, cross-sectional study that analyzed data on 5,231 children under 2 years of age participating in the National Health Survey of 2013. The study described the prevalence and Confidence Intervals (95% CI) of the three neonatal screening tests performed, in any period, and their association with the country's regions, skin color/ethnicity, private health insurance, and per capita household income. Logistic regression models were used, and odds ratios were calculated by incorporating sample weights. RESULTS The prevalence of Guthrie test screening in Brazil at any time of life was 96.5%, that of the newborn hearing screening was 65.8% and that of the red reflex screening test was 60.4%. The performance of the three screening tests was significantly higher among children whose mothers/guardians reported higher per capita household income, who lived in the South and Southeast regions, and who had private health insurance (p<0.001). There was no statistically significant difference regarding the performance of the tests according to skin color/ethnicity (p>0.05). The same inequalities were verified when the tests were performed during the recommended periods, with a strong socioeconomic gradient. CONCLUSIONS There are inequalities in the performance of neonatal screening tests in the country, and also in the performance of these tests during the periods established in the governmental guidelines. The guarantee of the performance of these tests in a universal and public health system, as in Brazil, should promote equity and access to the entire population.
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Affiliation(s)
- Mariana B Mallmann
- Universidade Federal de Santa Catarina (UFSC), Faculdade de Medicina, Florianópolis, SC, Brazil
| | - Yaná T Tomasi
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
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Ivo ML, de Araujo OMR, Barbieri AR, Corrêa Filho RAC, Pontes ERJC, Botelho CADO. Scope and efficiency of the newborn screening program in identifying hemoglobin S. Rev Bras Hematol Hemoter 2014; 36:14-8. [PMID: 24624030 PMCID: PMC3948660 DOI: 10.5581/1516-8484.20140007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/16/2013] [Indexed: 11/27/2022] Open
Abstract
Background In 2001, the Brazilian Ministry of Health added hemoglobinopathies to the National Neonatal Screening Program to be implemented in three steps. In order to meet the proposed goals, it is crucial to establish periodic assessments of this program with the aim of monitoring its implementation. Objective To assess the scope and the efficiency of the stages of the National Newborn Screening Program in identifying hemoglobin S. Methods A cross-sectional study was developed with the results of the heel prick test using the high performance liquid chromatography method for babies born in Mato Grosso do Sul from 2006 to 2010. The following variables were investigated: year, number of live births, total screening, coverage ratio, prevalence, time between the child birth and the blood collection; age at diagnosis; age at the time of the first consultation; and time between the diagnosis and the first appointment. Results Over the five years of the study, the mean coverage rate was 91.77%. The prevalences of hemoglobin FAS and hemoglobin FS were 1.65% and 0.011%, respectively. Blood samples from 43.48% of children were collected from the second to the seventh day. The age at diagnosis was within the first 28 days in 87.80% of the screened children. The lowest mean indices for the first consultation and the time between the diagnosis and the first appointment (58.8 and 46.4 days, respectively) occurred in 2010. Conclusions The scope of the National Neonatal Screening Program for hemoglobinopathies is good, with a large number of individuals being tested. Efficiency is a suitable indicator to assess the program steps. Three points are recommended: the training of the individuals involved, studies to assess the assistance provided to the affected child, and genetic counseling to the mothers. © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.
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Affiliation(s)
- Maria Lúcia Ivo
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | | | - Ana Rita Barbieri
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
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Botler J, Camacho LAB, Cruz MMD. Avaliação das unidades de coleta do Programa de Triagem Neonatal no Estado do Rio de Janeiro. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2012. [DOI: 10.1590/s1519-38292012000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: avaliar estrutura e processo das unidades de coleta (UC) e incluindo coleta e transporte das amostras, e busca ativa do Programa de Triagem Neonatal do Estado do Rio de Janeiro (PTN-RJ). MÉTODOS: foram selecionadas 66 das 422 UC existentes, conforme tipo, localização e volume de amostras. Foram aplicados questionário semi-estruturado e roteiros para observação direta e análise documental. Foram gerados escores para estrutura e processo para cada UC. Foram calculadas medianas da pontuação, avaliada a consistência interna do instrumento, correlação de escores entre estrutura e processo. RESULTADOS: o escore mediano global (máximo de 100) foi de 69,1 (variação: 50,5-86,6) para estrutura e 63,9 (variação: 46,9-77,4) para processo. O desempenho das UC foi semelhante em estrutura. Maternidades e PSF tiveram desempenhos superiores em processo, e UCB inferiores. O coeficiente alfa de Cronbach indicou alta consistência dos instrumentos para avaliação de estrutura (alfa=0,93) e processo (alfa=0,81). Os escores de estrutura e processo apresentaram fraca correlação (coeficiente de Pearson = 0,44; Spearman = 0,42). Diferenças nos escores médios entre tipos de UC demonstraram considerável magnitude, porém sem significância estatística (p=0,387). CONCLUSÕES: o desempenho global em estrutura e processo foi satisfatório. As deficiências foram encontradas na capacitação de profissionais e suprimento de material para coleta e educativo.
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Botler J, Camacho LAB, Cruz MMD. Phenylketonuria, congenital hypothyroidism and haemoglobinopathies: public health issues for a Brazilian newborn screening program. CAD SAUDE PUBLICA 2012; 28:1623-31. [DOI: 10.1590/s0102-311x2012000900002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 06/25/2012] [Indexed: 11/22/2022] Open
Abstract
In this study, the frequency of detected congenital hypothyroidism, phenylketonuria and haemoglobinopathies in the State of Rio de Janeiro's (Brazil) Newborn Screening Program (NBSP) was analyzed between the years of 2005 and 2007. There were two Newborn Screening Reference Centers (named NSRC A and B) with programmatic differences. In 2007, overall detection coverage reached 80.7%. The increase in the incidence of congenital hypothyroidism (1:1,030 in 2007) was attributed to the reduction of neonatal TSH value limits over time. The incidence discrepancy of phenylketonuria between NSRC A (1:28,427) and B (1:16,522) might be partially explained by the small number of cases. The incidence of sickle cell disease and its traits were uniformly high (1:1,288 and 1:21, respectively). This was coherent with the ethnic composition of the population. The differences in laboratory methods and critical values, in addition to other programmatic issues, may explain the variances in the results and limited analysis of the role of biological and environmental determinants in the occurrence of these diseases.
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