O presente estudo teve os seguintes objetivos: a) examinar os indicadores de desenvolvimento cognitivo, motor, de linguagem e sócio emocional de crianças nascidas pré-termo de alto risco neonatal em comparação a crianças nascidas a termo sem condição de vulnerabilidade biológica no início do desenvolvimento, até os 15 primeiros meses de idade corrigida para prematuridade (ICo); b) examinar os indicadores de desenvolvimento especificamente no grupo de prematuros, comparando os respectivos sub-grupos de acordo com: nível de prematuridade (extremo e muito prematuro), presença ou ausência de hemorragia intracraniana e presença ou ausência da condição gemelaridade; c) identificar as variáveis preditoras do desenvolvimento das crianças nascidas pré-termo, considerando-se variáveis neonatais clínicas e psicossociais. Participaram do estudo 133 crianças, de ambos os sexos, sendo 54 nascidas pré-termo (PT) e 79 nascidas a termo (AT), e suas respectivas mães, no primeiro ano de idade, que nasceram no Complexo HCFMRP-USP. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do HCFMRP-USP, Processo HC n° 8244/2016. Na coleta de dados, o desenvolvimento das crianças foi avaliado pelas Escalas Bayley-III (cognitiva, motora, de linguagem e sócio emocional). Além disso, foram aplicados questionários de caracterização da amostra e a Escala ABEP - Associação Brasileira de Empresas de Pesquisa (2014). Os indicadores clínicos neonatais foram analisados a partir dos prontuários médicos das crianças. Na análise de dados, inicialmente, foi processada a análise estatística descritiva das características da amostra e dos indicadores de desenvolvimento. Em seguida, foi realizada a análise estatística inferencial de comparação entre grupos por meio dos testes t-independente de Student (variáveis contínuas) ou Qui-Quadrado (variáveis categóricas). Utilizou-se os testes MANOVA e ANOVA para examinar as potenciais diferenças entre os grupos, relacionadas aos indicadores de desenvolvimento das crianças controlando-se as variáveis idade da criança e nível sócio-econômico. Além disso, foram realizadas análises de regressão linear múltiplas com a amostra de crianças nascidas pré-termo, examinando-se as interações entre as variáveis preditoras (tempo de internação na UTIN, tempo de internação total e tempo de uso do Continuous Positive Airway Pressure - CPAP), as variáveis preditas nos modelos foram os escores do desenvolvimento (cognitivo, linguagem, motor e sócio emocional), na fase de 6-8 e 12-15 meses ICo. Por fim, foi realizada a análise de comparação intra-grupo (6-8 vs 12-15 meses ICo) por meio dos testes de t-pareado, para variáveis contínuas (escores da Bayley-III) e do teste de Wilcoxon para variáveis categóricas (classificações da Bayley-III). Os dados foram analisados pelo Statistical Package for Social Sciences (SPSS, versão 25.0, Chicago, Il, USA). O nível de significância adotado no estudo foi de p <= 0,05. Os resultados mostraram que as crianças do grupo PT, tanto na fase de 6-8, quanto na fase de 12-15 meses ICo, apresentaram menores escores médios, em todos os indicadores avaliados pelas Escalas Bayley-III (cognitivo, de linguagem, motor e sócio emocional), em comparação com o grupo AT. Apesar de haver diferenças entre os grupos, a maioria das crianças nascidas prematuras estavam com o desenvolvimento na faixa de normalidade pelas normas das escalas. Esses achados foram independentes do nível de prematuridade, da presença de hemorragia intracraniana ou história de gemelaridade. Verificou-se ainda que os escores médios dos indicadores de desenvolvimento dos dois grupos (PT e AT) aos 12-15 meses ICo não foram maiores do que aos 6-8 meses ICo. No entanto, ainda que não tenha sido observada uma evolução no desenvolvimento, as crianças de ambos os grupos estavam com o desenvolvimento na faixa de normalidade pelas normas das escalas Bayley-III. Por fim, o tempo de internação na UTIN e o tempo de uso do CPAP foram os principais fatores de risco preditores para problemas no desenvolvimento cognitivo, motor, de linguagem e sócio emocional das crianças nascidas pré-termo / The present study had the following objectives: a) to examine the indicators of cognitive, motor, language and socio emotional development of neonatal high-risk preterm infants in comparison to infants born full-term without biological vulnerability condition at the beginning of the development, until the first 15 months of corrected age for prematurity (Co); b) to examine the developmental indicators specifically in the preterm group, comparing the respective subgroups according to: prematurity level (extreme and very premature), presence of intracranial hemorrhage and condition of being a twin; c) to identify the predictive variables of the development of preterm infants, considering neonatal clinical and psychosocial variables. The study consisted of 133 children of both sexes, being 54 born preterm (PT) and 79 born full-term (FT), and their respective mothers, in the first 15 months Co, born in the HCFMRP-USP Complex. The project was approved by the Research Ethics Committee of HCFMRP-USP. In data collection, the development of the infants was evaluated by the Bayley-III Scales (cognitive, motor, language and socio emotional). In addition, sample characterization questionnaires and the ABEP - Brazilian Association of Research Companies (2014) scale were applied. The neonatal clinical indicators were analyzed based on the medical records. In the data analysis, the descriptive statistical analysis of sample characteristics and development indicators was performed. Then, the inference statistical analysis of the comparison between groups was done by Student\'s independent t-test (continuous variables) or Chi-Square (categorical variables). The MANOVA and ANOVA tests were used to examine the potential differences between the groups, related to the developmental indicators of the children, controlling the age of the child and socio-economic level. In addition, multiple linear regression analyzes were performed with the preterm infants sample, examining the interactions among the predictor variables (length of stay in the NICU, length of stay in the hospital and time of use of the Continuous Positive Airway Pressure - CPAP), the predicted variables in the models were the development scores (cognitive, language, motor and socio emotional), in the 6-8 and 12-15 months Co phases. Finally, the intra-group comparison analysis (6-8 vs. 12-15 months ICo) was performed through t-paired tests for continuous variables (Bayley-III scores) and the Wilcoxon test for categorical variables (Bayley-III ratings). The data were analyzed by the Statistical Package for Social Sciences (SPSS, version 25.0, Chicago, Il, USA). The level of significance adopted in the study was p <= 0.05. The results showed that infants in the PT group, both in the 6-8 and in the 12-15 months Co phases, presented significantly lower mean scores in all indicators assessed by the Bayley-III Scales (cognitive, language, motor and socio emotional) compared to the FT group. Although there were differences between groups, the majority of the infants born preterm were developing in the normal range based on the norms of the scales. These findings were independent of the level of prematurity, the presence of intracranial hemorrhage or the condition of being a twin. It was also verified that the mean scores of the development indicators of the two groups (PT and FT) at 12-15 months Co were not higher than at 6-8 months Co. However, although developmental progress was not observed, the children of both groups were developing in the normal range based on the norms of the Bayley-III scales. Finally, length of stay in the NICU and duration of CPAP use were the main predictor risk factors for cognitive, motor, language and socio emotional problems in preterm infants

Background: Patients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common. Methods: Between 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression. Results: Of 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60–69 years, aOR, 0.30, 95% C.I, 0.108–0.850, p < 0.05), (70–79 years aOR, 0.27, 95% C.I, 0.096–0.734, p < 0.05), (80+ years aOR, 0.16, 95% C.I, 0.057–0.430, P < 0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score > 7 (reference <7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055–0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027–0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356–0.928 P < 0.05). Conclusion: Our findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.

When even seemingly benign and routine processes fail in healthcare, people sometimes die. The profound effect on the patient’s families and the healthcare staff involved is clear (Vincent and Coulter, 2002), while further consequences are felt by the institution involved, both financially and by damage to reputation. The trend in healthcare for learning through experience of adverse events is no longer a viable philosophy (Department of Health,Sir Ian Carruthers OBE and Pauline Philip, 2006). In order to make progress towards preventative learning, three Prospective Hazard Analysis (PHA) methods used in other industries were evaluated for use in the area of ward based healthcare. Failure Modes and Effects Analysis (FMEA), Fault Tree Analysis (FTA) and Hazard and Operability Analysis (HAZOP) were compared to each other in terms of ease of use, information they provide and the manner in which it is presented. Their results were also compared to baseline data produced through empirical research. Oxygen Therapy was used in this research as an example of a common ward based therapy. The resulting analysis listed 186 hazards almost all of which could lead to death, especially if combined. FTA and FMEA provided better system coverage than HAZOP and identified more hazards than were contained in the initial hazard identification method common to both techniques. FMEA and HAZOP needed some modification before use, with HAZOP requiring the most extensive adjustment. FTA has a very useful graphical presentation and was the only method capable of displaying causal linkage, but required that hazards be translated into events for analysis. It was concluded that formal Prospective Hazard Analysis (PHA) was applicable to this area of healthcare and presented added value through a combination of detailed information on possible hazards and accurate risk assessment based on a combination of expert opinion and empirical data. This provides a mechanism for evidence based identification of hazard barriers and safeguards as well as a method for formal communication of results at any stage of an analysis. It may further provide a very valuable vehicle for documented learning through prospective analysis incorporating feedback from previous experience and adverse incidents. The clear definition of systems and processes that form part of these methods provides a valuable opportunity for learning and the enduring capture and dissemination of tacit knowledge that can be continually updated and used for the formulation of strategies for safety and quality improvement.

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第20504号 / 情博第632号 / 新制||情||110(附属図書館) / 京都大学大学院情報学研究科知能情報学専攻 / (主査)教授 鹿島 久嗣, 教授 山本 章博, 教授 阿久津 達也 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

OBJECTIVE To determine the prevalence of patients with diabetes mellitus (DM2) in Valencia. Moreover, the analysis of population characteristics, disease profile, multimorbidity, pharmaceutical costs, resource consumption and complications We want to establish a prediction model resource consumption of patients with type II diabetes mellitus (DM 2). STUDY DESIGN Methodology Observational, descriptive, retrospective and cross-sectional study. First of all, a database is prepared with patients diagnosed with DM2 in Valencia in 2012. They are rank by their state health system using the Clinical Risk Groups (CRG). From this database, comorbidities and specific complications associated with the disease and pharmaceutical expenditure are analyzed. This is analyzed from different perspectives: comorbidities, CRG health conditions and drugs used to treat the disease. As a result, a multivariate regression models arises to predict pharmaceutical expenditure depending on the different available variables in which the dependent variable is the total pharmaceutical expenditure per patient per year and the explanatory variables will be selected from among those available in the data base developed. Finally, a factorial analysis and principal component analysis is presented to study differences among diabetic patients analyzed in terms of pharmaceutical expenditure, comorbidities not related to DM2, DM2-related comorbidities and complications. Study Population Population diagnosed with type II diabetes of Valencia in the year 2012. Of the 491,854 patients diagnosed with diabetes. We excluded all patients with juvenile diabetes, gestational diabetes and those who received no drug treatment, reducing the group to 350,015 patients. Sources of information and study variables: The basic sources for obtaining data was: - The electronic medical record, ABUCASIS. - The module pharmaceutical services, GAIA. - The Minimum Data Set, CMBD. - The catalog of corporate resources, CRC. - Population Information System, SIP. - Clinical Risk Groups (Clinical Risk Groups, CRGs). Limitations of the study 1. State of coding diagnoses, both in quantitative and qualitative terms. 2. Imbalance in the use of corporate systems outpatient, which enables errors in classification information (SIA-GAIA) RESULTS The estimated gross rate of diabetes was 7.72%, with an average consumption per patient per year was approximately € 1,330. Considering health states, about 48% of patients are classified in health status 6. As for comorbidities of patients with DM2, 68% also suffer from hypertension and 53% of dyslipidemia. The prevalence of comorbid increases with CRG health status and the severity of the patient; and older ages. As expected, also it increases with the number of comorbidity (from 592 € per patient per year with one comorbidity to 3,825 € to six and more comorbidity). By type of pharmaceutical treatment, consumption is lower in biguanides and sulfonylureas, with annual amounts lower to 50 € and achieves amounts over 600 €. Finally models predictive for diabetic patients are raised, with the proposed model considering multivariate linear regression health status and severity of the patient according to the CRG system model. Moreover, the proposed analysis identifies six factors explaining 49.3% of the variance in the pharmaceutical annual consumption of diabetic patients. CONCLUSIONS DM2 shows a high prevalence and is characterized by the coexistence of other diseases, which leads to significant increases in the cost of treatment and complicates the management of the disease. Per patient consumption increases with worsening state of health of the patient and older age, and is also determined by the type of pharmaceutical treatment following by patients. Linear regression and factor analysis allow to establish models to predict and control the pharmaceutical consumption of diabetic patients. / OBJETIVO Determinación de la prevalencia y análisis de las características de la población, perfil de morbilidad, multimorbilidad, costes farmacéuticos, consumo de recursos y complicaciones de los pacientes con Diabetes mellitus (DM2) en la Comunidad Valenciana. Con ello, se pretende establecer un modelo de predicción del consumo de recursos de los pacientes con Diabetes mellitus tipo 2 (DM 2). DISEÑO DEL ESTUDIO Metodología Estudio observacional, descriptivo, retrospectivo y de corte transversal. Se elabora una base de datos con los pacientes diagnosticados de DM2 en la Comunidad Valenciana en el año 2012 y se clasifica a los mismos por estados de salud, utilizando el sistema Clinical Risk Groups (CRG). Se analizan las comorbilidades y complicaciones específicas asociadas a la enfermedad así como el gasto farmacéutico. Este se analiza desde diferentes puntos de vista: comorbilidades, estados de salud CRG y fármacos utilizados para el tratamiento de la enfermedad. Con todo ello, se plantea modelos de regresión multivariante para predecir el gasto farmacéutico en función de las diferentes variables disponibles en los que la variable dependiente es el gasto farmacéutico total por paciente y año y las variables explicativas se seleccionarán, de entre las disponibles en la base de datos elaborada. Finalmente, se presenta un análisis factorial y de componentes principales para estudiar diferencias entre los pacientes diabéticos analizados, en cuanto a gasto farmacéutico. Población de estudio Población con diagnóstico de diabetes tipo 2 de la Comunidad Valenciana en el 2012. De los 491.854 pacientes con diagnóstico de diabetes, se excluyen todos aquellos pacientes con diabetes juvenil, diabetes gestacional y los que no recibieron tratamiento farmacológico, reduciendo el grupo a 350.015 pacientes. Fuentes de información y variables de estudio Las fuentes fundamentales para la obtención de los datos: -La historia clínica electrónica, ABUCASIS. -El módulo de prestación farmacéutica, GAIA. -El Conjunto Mínimo Básico de Datos, CMBD. -El catálogo de recursos corporativos, CRC. -Sistema de Información Poblacional, SIP. -Los Grupos de Riesgo Clínico (Clinical Risk Groups, CRGs). Limitaciones del estudio 1.Estado de la codificación de los diagnósticos, tanto en términos cuantitativos como cualitativos. 2. Desequilibrio en la utilización de los sistemas de información ambulatorios corporativos con posibilidad de clasificaciones erróneas (SIA-GAIA). RESULTADOS La prevalencia bruta estimada de la diabetes fue del 7,72%, con un consumo medio por paciente y año de cerca de 1.330€. Por estados de salud, cerca de 48% de los pacientes se clasifican en el estado de salud 6. En cuanto a las comorbilidades de los pacientes con DM2, el 68% sufren además hipertensión y un 53% dislipemia. El gasto farmacéutico aumenta con la presencia de comorbilidades (de 592€ a 3.825€ anuales por paciente, con una comorbilidad a seis y más, respectivamente)., el estado de salud CRG y la severidad del paciente; y con edades más avanzadas. Por tipo de fármaco, el consumo varía entre importes anuales inferiores a 50€ hasta cifras que superan los 600€. Un modelo de regresión lineal multivariante que considera el estado de salud y severidad del paciente alcanza un coeficiente de determinación corregido¿R2 de un 39,3% de la variabilidad. Finalmente, el análisis factorial identifica 6 factores que explican el 49,3% de la varianza en el consumo anual farmacéutico de los pacientes diabéticos. CONCLUSIONES La diabetes presenta una elevada prevalencia y se caracteriza por la coexistencia de otras enfermedades, lo cual conlleva incrementos considerables en el coste del tratamiento. El consumo por paciente aumenta con el empeoramiento del estado de salud del paciente y la edad más avanzada, así como por el tipo de tratamiento farmacológico del paciente. La r / OBJECTIU Determinació de la prevalença i anàlisi de les característiques de la població, perfil de morbiditat, multimorbilitat, costos farmacèutics, consum de recursos i complicacions dels pacients amb Diabetis Mellitus (DM2) a la Comunitat Valenciana (CV). Es pretén establir un model de predicció del Consum de recursos dels Pacients amb Diabetis Mellitus tipus II (DM 2). DISSENY DE L'ESTUDI Metodologia Estudi observacional, descriptiu, retrospectiu i de tall transversal. En primer s'elabora una base de dades amb els pacients amb diagnòstic de DM2 a la Comunitat Valenciana en l'any 2012 i es classifica als pacients per estats de salut, utilitzant del sistema de Grups de Risc Clínic (CRG). S'analitzen les comorbiditats i complicacions associades a la infermetat, així com la despesa farmacèutica des de diferents perspectives: comorbiditats, estats de salut i fàrmacs utilitzats per al tractament de la malaltia. Es plantegen models de regressió multivariant per predir la despesa farmacèutica en funció de les diferents variables disponibles. La variable dependent es la despesa farmacèutica total per pacient i any, i les variables explicatives es seleccionaran, d'entre les disponibles a la base de dades elaborada. Finalment, a la tesi, es presenta l'anàlisi factorial i de components principals que ens permet estudiar les diferències entre els pacients diabètics analitzats, des del punt de vista de la despesa farmacèutica, comorbiditats relacionades i no relacionades amb la DM2 i complicacions. Població d'estudi Població amb Diagnòstic de diabetis (DM 2) de la Comunitat Valenciana en l'any 2012. Dels 491.854 pacients amb diagnòstic de la diabetis, s'exclouen de els pacients amb diabetis juvenil, diabetis gestacional i els que no van rebre tractament farmacològic, reduint el grup a 350.015. Fonts d'Informació i variables d'estudi - La història clínica electrònica, ABUCASIS. - El mòdul de prestació farmacèutica, GAIA. - El Conjunt Mínim de Dades Bàsiques, CMBD. - El catàleg de recursos corporatius, CRC. - Sistema d'Informació Poblacional, SIP. - Els Grups de Risc Clínic (grups de risc clínics, CRGs). Limitacions de l'estudi 1. Estat de codificació dels diagnòstics, tant en termes quantitatius com qualitatius. 2. Desequilibri en la utilització dels sistemes d'informació corporatius ambulatoris amb possibilitat de classificació. RESULTATS La prevalença bruta estimada de la diabetis va ser del 7,72, i el consum mitjà per pacient i any de uns 1.330€. Per estats de salut, prop de 48% dels pacients es classifiquen en l'estat de salut 6, i al voltant del 29% en el 5. En quant a les comorbiditats dels Pacients amb DM2, el 68% pateixen hipertensió, i un 53% dislipèmia. La despesa augmenta amb la presencia de comorbiditats (de 592 € a 3.825 € per pacient anualment, amb una comorbiditat i amb una sis i més, respectivament), així com amb l'estat de salut del CRG i la severitat del pacient. Per tipus de fàrmac, el consum és més baix en biguanides i sulfonilurees, amb imports anuals inferiors a 50 € fins a més de 600€ en el cas de combinacions. Es plantegen models per predicció del consum farmacèutic ambulatori de pacients diabètics del tipus 2, proposant com a resultat un model de regressió lineal multivariant que considera l'estat de salut i severitat del pacient segons el sistema CRG. D'altra banda, l'anàlisi factorial identifica 6 factors que expliquen de l'49,3% de la variància a el consum anuals farmacèutic dels pacients. CONCLUSIONS La diabetis presenta una elevada prevalença i es caracteritza per la coexistència d'altres malalties, la qual cosa comporta increments considerables en el cost del tractament i complica la gestió de la malaltia. El consum per pacient augmenta amb l'empitjorament de l'estat de salut del pacient i l'edat avançada, i a més també ve determinat pel tipus de tractament farmacològic que segueixen e / Sancho Mestre, C. (2017). MODELO PREDICTIVO DE AJUSTE DE RIESGO Y COSTES EN PACIENTES CON DIABETES MELLITUS EN LA COMUNIDAD VALENCIANA [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/83483

An in-depth analysis of organizational risk management in health care, and in particular the concepts of Enterprise Risk Management (ERM), has identified a five part model that can be used by Canadian health care leaders as an evidence supported approach to successful organizational risk management. The Model for Organizational Risk Management has been developed as a basis for linking the components of an ERM framework into a Canadian health organization in order to overcome the barriers that commonly disrupt strategic risk management. The Model addresses how an ERM framework can fit within an existing health organization by building off of and enhancing existing processes and resources in order to ensure familiarity, acceptance, and sustainability of the risk management program. By approaching the Model in a stepwise fashion (based on individual organizational context) health care leaders are provided with a roadmap from which to advance their own organizational risk management program.

An in-depth analysis of organizational risk management in health care, and in particular the concepts of Enterprise Risk Management (ERM), has identified a five part model that can be used by Canadian health care leaders as an evidence supported approach to successful organizational risk management. The Model for Organizational Risk Management has been developed as a basis for linking the components of an ERM framework into a Canadian health organization in order to overcome the barriers that commonly disrupt strategic risk management. The Model addresses how an ERM framework can fit within an existing health organization by building off of and enhancing existing processes and resources in order to ensure familiarity, acceptance, and sustainability of the risk management program. By approaching the Model in a stepwise fashion (based on individual organizational context) health care leaders are provided with a roadmap from which to advance their own organizational risk management program.

Made available in DSpace on 2014-07-29T15:29:13Z (GMT). No. of bitstreams: 1 Dissertacao Suelene Brito do Nascimento Tavares.pdf: 1452329 bytes, checksum: 6d86236e3c08daf9227c6b9f207128b7 (MD5) Previous issue date: 2007-09-06 / Cytopathology is an effective method of screening for cervical cancer; however, this method has high rates of false-negative results (FNR). To reduce FNR, routine measures of internal and external quality control are required in laboratories. The 10% random review of negative smears (R-10%) is the most commonly used method; however, it is not effective in reducing FNR. Nevertheless, there is evidence that the review of smears selected according to clinical risk factors (RCRF) and rapid prescreening (RPS) of all smears present good results. This study evaluated the performance of RPS, R-10% and RCRF as methods of internal quality control of cervical smear testing. The sample was composed of a total of 6,135 cervical smears from women who had attended Basic Health Clinics in Goiânia Goiás between March 2006 and March 2007. The cytopathological results were classified according to the 2001 Bethesda System. Initially, 6,135 smears were submitted to RPS followed by routine scrutiny (RS). Following RS, smears classified as negative were selected on the basis of clinical risk criteria, while 10% of all the smears were selected randomly, both sets then being submitted to the respective reviews. Four cytologists were responsible for RPS, RS, R-10% and RCRF, and three for reviewing the abnormal and discordant smears from any of the reviews. The smears classified as negative in RPS, RS, R-10% and RCRF were considered to have a final diagnosis (FD) of negative. Smears considered suspect or unsatisfactory at RPS were analyzed separately by two other cytologists. Smears considered abnormal or unsatisfactory at RS, R-10% and/or RCRF were likewise reviewed. When the two reviewing cytologists reached concordant diagnoses, these were considered the FD. Discordant results were analyzed by a third cytologist and a consensus meeting was held to define the FD. All stages of the study were performed blinded except for the consensus meeting. Smears classified as negative at RS, which were suspect at RPS and/or considered abnormal at R-10% and RCRF and confirmed abnormal in the FD, were considered FN results. Of the 6,135 smears, 5,522 were classified as negative, 84 as unsatisfactory and 529 as abnormal in the FD. Sensitivity of RPS was 63.0% for all abnormalities and 96.7% for high-grade squamous intraepithelial lesion (HSIL) compared to RS. The sensitivity of RPS was 74.9% for all abnormalities and 95.0% for HSIL compared to FD. The sensitivity of R-10% was 53.8% for all abnormalities when compared to FD. R-10% failed to detect any cases of HSIL. The sensitivity of RCRF was 64.0% for all abnormalities and 75.0% for HSIL compared to the FD. RPS identified an additional 132 (2.15%) abnormal smears, whereas R-10% and RCRF identified an additional 7 (0.11%) and 32 (0.52%), respectively. In conclusion, RPS is an effective method of internal quality control and has better sensitivity than R-10% and RCRF for the detection of FN results. It also allows the FN rate of the laboratory to be monitored and permits continuous evaluation of the prescreening cytologist and the routine screening cytologist. / O exame citopatológico é um método eficiente para prevenir o câncer do colo do útero, no entanto, apresenta altas taxas de resultados falso-negativos (RFN). Para reduzir os RFN, são necessárias medidas de controle interno e externo da qualidade na rotina dos laboratórios. O método de revisão aleatória de 10% dos esfregaços negativos (R-10%) é o mais utilizado, no entanto, não é eficiente para reduzir os RFN. Porém, há evidências de que a revisão dos esfregaços selecionados por critérios clínicos de risco (RCCR) e o pré-escrutínio rápido (PER) apresentam bons resultados. Esse estudo comparou o desempenho do PER, R-10% e RCCR como métodos de controle interno da qualidade dos esfregaços cervicais. A casuística foi constituída por 6.135 esfregaços citopatológicos cervicais de mulheres atendidas nas Unidades Básicas de Saúde de Goiânia GO, no período de março de 2006 a março de 2007. Os resultados citopatológicos foram classificados de acordo com o Sistema de Bethesda 2001. Inicialmente 6.135 esfregaços foram submetidos ao PER e em seguida ao escrutínio de rotina (ER). Após o ER os esfregaços classificados como negativos foram selecionados com base em critérios clínicos de risco e aleatoriamente 10% do total de esfregaços e submetidos às respectivas revisões. Quatro citologistas foram responsáveis pelo PER, ER, R-10% e RCCR e três pelas revisões dos esfregaços alterados e discordantes em qualquer revisão. Os esfregaços com resultados negativos no PER, ER, R-10% e RCCR foram considerados diagnóstico final (DF). Os esfregaços com resultados suspeitos ou insatisfatórios, pelo PER, foram analisados separadamente por dois outros citologistas. Também os esfregaços cujos resultados foram considerados alterados ou insatisfatórios pelo ER, R-10% e/ou RCCR foram igualmente revisados. Quando os dois citologistas revisores emitiram diagnósticos concordantes estes foram considerados DF. Os resultados discordantes foram analisados por um terceiro citologista e em uma reunião de consenso foi definido o DF. Todas as etapas do estudo foram realizadas às cegas, exceto na reunião de consenso. Os esfregaços classificados como negativos pelo ER que foram suspeitos pelo PER e/ou alterados nas R-10% e RCCR e confirmados pelo DF foram considerados RFN. Dos 6.135 esfregaços, 5.522 foram classificados como negativos, 84 como insatisfatórios e 529 como alterados pelo DF. A sensibilidade do PER foi de 63,0% para todas as anormalidades e de 96,7% para lesão intra-epitelial escamosa de alto grau (HSIL) quando comparado ao ER. A sensibilidade do PER foi de 74,9% para todas as anormalidades e de 95,0% para HSIL quando comparado ao DF. A sensibilidade da R-10% foi de 53,8% para todas as anormalidades quando comparado ao DF e não detectou nenhuma HSIL, enquanto a sensibilidade da RCCR foi de 64,0% para todas as anormalidades e de 75,0% para HSIL quando comparado ao DF. O PER acrescentou 132 (2,15%) esfregaços alterados, enquanto que a R-10% e a RCCR acrescentaram sete (0,11%) e 32 (0,52%), respectivamente. Enfim, o PER é uma alternativa eficiente de controle interno da qualidade, apresentando maior sensibilidade que as R-10% e RCCR na detecção de RFN. Permite, ainda, monitorar a taxa de RFN do laboratório, assim como avaliar continuamente o desempenho tanto do pré-escrutinador quanto do escrutinador de rotina.

The aim of this study was to determine the prevalence and causes as well as the risk factors of visual impairment (VI) and blindness among Black South Africans with diabetes mellitus (DM) aged 40 years and older in Mopani District, Limpopo province, South Africa. This was a cross-sectional study in which Black South Africans with DM aged ≥40 years old were examined for VI and blindness. In addition, anthropometric as well as risk factors for VI and blindness were studied. A total of 225 participants were selected from seven Public Health Facilities in Mopani District. Data was collected using standard optometric instruments, anthropometric instruments and structured interviews. Data analysis was done using the Statistical Analysis System (SAS) and Microsoft Excel software packages. The ages of the participants ranged from 40 to 90 years with a mean of 61.5±10.49 years. There were more females (71.5%) than males (28.4%). The prevalence of uncorrected VI and blindness in the right eyes of the participants was 70.7% and 3.6%, respectively. In the left eyes, it was 72% and 3.1%, respectively. However, following optical correction, the prevalence in right eyes was 41.3% and 3.6%, respectively. In the left eyes, it was 42.2% and 3.1%, respectively. Risk factors that were individually associated with VI and blindness include age, educational qualification, monthly income, knowledge of DM types, oral DM treatment (pills), losing weight, compliance to losing weight, family history of DM, physical activity, and date of last eye examination .When logistic regression was used, knowledge of DM types, pills, and compliance to losing weight, family history of DM, monthly income and physical activity remained associated with VI and blindness. The high prevalence of VI in this diabetes population was not primarily due to DM itself, but due to refractive error and cataract, conditions which have effective and easy treatments. A total of 84% of the participants were visually impaired due to either refractive error or cataract or both and only 3.8% due to diabetes retinopathy. It is therefore recommended that appropriate and affordable refraction and cataract surgical services be made available and accessible to this population / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to determine the prevalence and causes as well as the risk factors of visual impairment (VI) and blindness among Black South Africans with diabetes mellitus (DM) aged 40 years and older in Mopani District, Limpopo province, South Africa. This was a cross-sectional study in which Black South Africans with DM aged ≥40 years old were examined for VI and blindness. In addition, anthropometric as well as risk factors for VI and blindness were studied. A total of 225 participants were selected from seven Public Health Facilities in Mopani District. Data was collected using standard optometric instruments, anthropometric instruments and structured interviews. Data analysis was done using the Statistical Analysis System (SAS) and Microsoft Excel software packages. The ages of the participants ranged from 40 to 90 years with a mean of 61.5±10.49 years. There were more females (71.5%) than males (28.4%). The prevalence of uncorrected VI and blindness in the right eyes of the participants was 70.7% and 3.6%, respectively. In the left eyes, it was 72% and 3.1%, respectively. However, following optical correction, the prevalence in right eyes was 41.3% and 3.6%, respectively. In the left eyes, it was 42.2% and 3.1%, respectively. Risk factors that were individually associated with VI and blindness include age, educational qualification, monthly income, knowledge of DM types, oral DM treatment (pills), losing weight, compliance to losing weight, family history of DM, physical activity, and date of last eye examination .When logistic regression was used, knowledge of DM types, pills, and compliance to losing weight, family history of DM, monthly income and physical activity remained associated with VI and blindness. The high prevalence of VI in this diabetes population was not primarily due to DM itself, but due to refractive error and cataract, conditions which have effective and easy treatments. A total of 84% of the participants were visually impaired due to either refractive error or cataract or both and only 3.8% due to diabetes retinopathy. It is therefore recommended that appropriate and affordable refraction and cataract surgical services be made available and accessible to this population / Health Studies / D. Litt. et Phil. (Health Studies)