Made available in DSpace on 2016-04-27T18:11:53Z (GMT). No. of bitstreams: 1 Helen Kopper Brasil.pdf: 1191046 bytes, checksum: 997e77c50079a077fccef8d2e8cc5b4d (MD5) Previous issue date: 2011-10-04 / Fundação de Amparo a Pesquisa do Estado de São Paulo / The early diagnosis and, consequently, the immediate amplification, as well as the therapeutical intervention and the family involvement, are indicators of success for the language development and for the hearing skills of children with hearing loss. Objective: To investigate the development of hearing and language capabilities of a group ofl children with congenital hearing. Methodology: This is a quantitative and qualitative research. It includes ten children with hearing loss, divided in two groups: with early and late diagnosis. All children were submitted to speech and hearing therapy and use hering aind or cochlear implant. All participants have speech perception and hearing with the electronic devices in the levels, suggested by Ling (1979) Results: time of use of hearing devices, the family involvement and amount of hearing experience showed good correlation with language development. When both groups were compared to each other, according to age at diagnosis, the language development and hearing skills, showed no statistical significance. Conclusion: The amount of hours which the child uses the hearing devices the family involvement, and amount of hearing experience are aspects that can influence the prognosis of children with hearing loss. The age of intervention did not show statistical significance between the two groups; concerning to hearing and language skills o for the children in this research / O diagnóstico precoce e, consequentemente, a amplificação imediata, bem como a intervenção terapêutica e o envolvimento familiar são indicadores de sucesso no desenvolvimento da linguagem e das habilidades auditivas de crianças deficientes auditivas. Objetivo: Investigar o desenvolvimento das habilidades auditivas e de linguagem de um grupo de crianças deficientes auditivas congênitas. Metodologia: Trata-se de uma pesquisa qualitativa e quantitativa, composta por 10 crianças deficientes auditivas, divididas em dois grupos: com diagnóstico precoce e casos com diagnóstico tardio. Todas frequentavam terapia fonoaudiológica, são usuárias de dispositivos de amplificação ou implante coclear e apresentavam ganho funcional e teste de percepção de fala dentro dos níveis sugeridos por Ling (1979) no espectro da Banana da fala (Banana da Fala). Materiais Utilizados: Escala Reynell, Escala de Envolvimento Familiar, Teste de Percepção de Fala (Sons de Ling), prontuário dos pacientes, Data Logging, Ganho Funcional e Audiometria Condicionada. Resultados:, A Idade Auditiva, o Envolvimento Familiar e o tempo de uso dos dispositivos eletrônicos durante o dia apresentaram correlação com o desenvolvimento de linguagem. Quando comparados os dois grupos, diagnóstico precoce e tardio, quanto aos resultados de linguagem e habilidades auditivas, não foi possível encontrar significância estatística entre eles. Conclusão: O tempo de uso diário de AASI e/ou IC, o envolvimento familiar e maior tempo de experiência auditiva (Idade Auditiva) são fatores determinantes no prognóstico da criança surda. Já a idade de início de intervenção não se mostrou estatisticamente significante entre os dois grupos; ou seja, o diagnóstico realizado antes de um ano de idade não interferiu nos resultados de habilidades auditivas e de linguagem dos voluntários nesta pesquisa, devendo ser pesquisado com maior casuística

Les troubles du Spectre Autistique (TSA) sont des troubles neuro-développementaux, d’apparition précoce et qui affectent le développement de l’individu tout au long de sa vie. La prévalence des TSA est estimée aux alentours de 1% de la population générale. Des interventions précoces peuvent minimiser le handicap résultant de ce trouble et améliorer la qualité de vie et l’insertion sociale des enfants. L’opportunité de bénéficier d’une intervention précoce dépend de l’âge du diagnostic. Aujourd’hui, l’âge moyen du diagnostic des TSA en France est de 5 ans en moyenne. Un diagnostic précoce est pourtant possible dès l’âge de 24 mois. Un dépistage précoce des TSA permettrait de diminuer l’âge du diagnostic et par conséquent l’âge du début de l’intervention, maximisant ainsi les bénéfices. L'objectif général de ce travail, organisé autour de 3 études, est de participer à l’amélioration des pratiques de dépistage et de diagnostic précoce des TSA en évaluant la pertinence de différents outils pour aider les professionnels à repérer et orienter les enfants à risque de TSA. La première étude a pour objectif d’évaluer la faisabilité d’un dépistage systématique des TSA chez les enfants âgés de 24 mois. Un dispositif de dépistage a été développé avec pour préalables la formation des professionnels de première ligne et la validation d’outils de dépistage spécifiques aux TSA : le CHAT et le M-CHAT. La seconde étude a pour objectif d’améliorer l’orientation diagnostique des enfants repérés pour une suspicion de TSA. Dans cette optique, cette étude vise à évaluer la pertinence de l’utilisation du module 1 de l’ADOS-G pour confirmer ou infirmer la présence d’un risque de TSA chez les enfants de moins de 3 ans. Enfin, l’objectif de la dernière étude est d’évaluer l’apport éventuel des données issues de l’évaluation développementale dans le dispositif. L’évaluation développementale des enfants permet de mettre en évidence leur profil et ainsi de proposer un plan d’intervention dans l’attente de la confirmation diagnostique. Les résultats de ces études témoignent de la possibilité de repérer les enfants à risque de TSA à 24 mois. Les professionnels impliqués dans la pratique de dépistage ont aujourd’hui à leur disposition deux outils validés sur un échantillon français: le CHAT et le M-CHAT. Ces outils présentent des propriétés psychométriques satisfaisantes pour une utilisation en population générale. L’utilisation du module 1 de l’ADOS-G permet de différencier les enfants de moins de 3 ans présentant un TSA des enfants avec une autre problématique développementale. Cet outil apparaît donc important pour améliorer la spécificité du dépistage précoce. L’évaluation développementale apporte quant à elle des informations sur les profils des enfants avec un TSA, marqués notamment par des déficits dans les domaines de l’imitation et du jeu. Les implications cliniques de ces études sont discutées et de nouvelles pistes de recherche sont proposées. / Autism Spectrum Disorder (ASD) is a neuro-developmental disorder with early onset affecting the development of person throughout their life. The prevalence of ASD is estimated approximately 1% of the general population. Early intervention can minimize disabilities resulting from the disorder and improve the quality of life and social inclusion of affected children. The opportunity to profit early interventions depends on the age of diagnosis. At the moment, the average age of diagnosis of ASD in France is 5 years. However, an early diagnosis is possible at the age of 24 months. Since early detection of ASD would reduce the age of diagnosis and the age of commence of the intervention as well, it concludes that it may maximize profits. The overall aim of this dissertation, organized in three studies, is to improve practice of screening and early diagnosis of ASD by evaluating the relevance of different tools employed by professionals to identify and refer children at risk ASD. The aim of first study is to evaluate the feasibility of ASD screening for 24 months old children. A screening program was developed with priority given to the training of frontline professionals and validation of two specific screening tools for ASD: CHAT and M-CHAT. The second study aims to improve the orientation of diagnostic practice for children with potential ASD. In this context, the objective is to assess the relevance of using Module 1of the ADOS-G in order to confirm or disprove the presence of a risk of ASD in children less than 3 years. Finally, the aim of the last study is to examine the developmental aspect of data obtained from the screening program and to find their potential implications. The assessment of at risk children may highlight their developmental profile; also it may help proposing an intervention plan before the confirmation of diagnostic. The results of these studies demonstrate that it is possible to identify children at risk for ASD at 24 months. Today, professionals involved in the practice of screening have at their disposal two screening tools validated in a French sample: CHAT and M-CHAT. These tools show satisfactory psychometric properties for the use in the general population. Children less than 3 years with ASD may be distinguished from other young children with developmental disorders by using the Module 1 of the ADOS-G. The use of this tool seems to be important to improve the specificity of early screening. The developmental assessment provides some information concerning the profiles of children with ASD, particularly has been marked by deficits in the areas of imitation and play. At last, the clinical implications of these studies are discussed and new lines for future research are proposed.

No período de março a maio de 2001, foram realizados os exames ultra-sonográficos em 88 ovelhas do Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia. Os animais foram examinados entre o 19°. e 33°. dia de gestação pela ultra-sonografia transretal com exames executados em dias alternados, e do 25°. ao 45°. dia pelo detector de prenhez para pequenos ruminantes (DPPR-80®). O diagnóstico foi considerado positivo pela ultra-sonografia transretal através da visualização do saco gestacional e embrião. Após o 25°. dia de gestação foi observado também o batimento cardíaco. Pelo detector de prenhez, a auscultação do batimento cardíaco embrionário, cuja freqüência é de 160 a 200 batimentos por minuto, foi dado como diagnóstico de gestação positivo. Dentre 88 fêmeas acasaladas, 3 abortaram durante o experimento e foram retiradas do grupo. Das 85 fêmeas restantes, 64 pariram. O diagnóstico de prenhez através da ultra-sonografia transretal apresentou 35,29% de acurácia no 19°.dia de gestação, culminando em 82,35% no 31°. dia de gestação. Pelo detector de prenhez, a acurácia foi de 24,71% no 25°.dia de gestação e 34,12% no 45°. dia. Foi possível visualizar os batimentos cardíacos do embrião pela ultra-sonografia transretal à partir do 21°. dia de gestação e os primeiros placentomas foram observados ao redor do 25°. dia de gestação. A ultra-sonografia transretal mostrou-se um método superior ao detector de prenhez para pequenos ruminantes, para diagnóstico precoce de gestação em ovelhas. / Ultrasonography was performed in 88 ewes from Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia, São Paulo state, from march to may, 2001. Animais were examined from 19°. to 33°. days of pregnancy by transrectal ultrasonography in alternate days examinations, and by pregnancy detector for small ruminants (DPPR-80®) from 25°. to 45°. day. Positive diagnostic by transrectal ultrasonography was obtained after yolk sac visualization. The embryo heartbeat was observed after 25 day of pregnancy. The positive diagnostic was obtained by pregnancy detector when embrionic heart rate was 160 to 200 beats/minute. Births confirmed the examinations. Three abortions occurred during the experiment and these females were excluded from the group. From 85 ewes examined, 64 lambed. The transrectal ultrasonography accuracy in 19°. day of pregnancy was 35,29%, with higher rate (82,53%) in 31°. day. The doppler accuracy in 25°. day was 24,71% and 34,12% in 45°. day. Embryo heartbeat was detected by transrectal ultrasonography after 21 days of pregnancy and the first placentoms were observed after 25 days of pregnancy. In conclusion, transrectal ultrasonography was better than doppler in early pregnancy diagnosis in sheep.

A sífilis é uma doença infecciosa, cujo agente etiológico é o Treponema pallidum. Pode ser transmitida sexualmente ou verticalmente, via placenta. Seus estágios variam entre sífilis primária, sífilis secundária, sífilis latente e sífilis congênita. Dentre os diagnósticos mais eficazes, encontram-se os testes sorológicos, porém os falsos positivos e falsos negativos no estágio primário levam à procura de uma forma mais eficaz de se determinar, precocemente, a doença. Além disso, por várias razões, nem sempre o profissional clínico suspeita das lesões presentes na mucosa oral, cogitando de outras hipóteses diagnósticas. O objetivo deste trabalho foi avaliar imuno-histoquimicamente e histoquimicamente lesões bucais biopsiadas cujo aspecto histológico levou à suspeita de sífilis, buscando identificar os microorganismos, bem como correlacionar o quadro sorológico quando positivo. Para o estudo foram incluídas 34 lesões suspeitas de sífilis, que foram submetidas à reação imuno-histoquímica com o anticorpo anti-treponema e técnica histoquímica de coloração pela prata. Dos 34 casos avaliados 13 foram positivos para o anticorpo anti-treponema, todos posteriormente diagnosticados como sífilis secundária, com positividade sorológica, exceto por um caso em que a sorologia não foi realizada. Quando se comparou os métodos de diagnóstico, a técnica de coloração por prata obteve sensibilidade de 46,15% e a de imuno-histoquímica foi de 92,3%. Os aspectos histológicos variaram em um grande número de achados, dentre eles: intensa exocitose, infiltrado inflamatório predominantemente plasmocitário (justaepitelial e perivascular), áreas de ulceração, epitélio paraqueratinizado, edema, espongiose e hiperplasia epitelial. A marcação imuno-histoquímica dos treponemas foi, principalmente, epitelial (61,5%) e esse método se mostrou um meio de diagnóstico rápido, simples e eficiente no diagnóstico de lesões orais de Sífilis. / Syphilis is an infectious disease, whose etiologic agent is Treponema pallidum. It can be transmitted sexually or vertically via the placenta. Its stages include primary syphilis, secondary syphilis, latent syphilis and congenital syphilis. Among the diagnoses most effective are the serological tests, but false positives and false negatives in the primary stage lead to demand for a more effective way to determine the disease earlier. In addition, for various reasons, not always the professional clinical suspicion of lesions present in the oral mucosa, thinking in other possible diagnoses. The objective of this study was to identify microorganisms and set the best way forward to a diagnostic framework confirmed positive serology. The results for syphilis lesions in the oral mucosa corresponded to 13 cases, all of secondary iinjuries,with positive serology for syphilis and in only one of them serology had not been held. In a comparison of diagnostic methods, the technique of silver staining achieved sensitivity of 46.15% and immunohistochemistry was 92.3%. The histological features varied in a large number of findings, including: intense exocytosis, inflammatory infiltrate, predominantly plasmacytic (banda-like and infiltrate perivascular), areas of ulceration, parakeratinized epithelium, edema, spongiosis and epithelial hyperplasia. The immunohistochemical staining of treponemes was mainly epithelial (61.5%) and this method was a rapid, simple and efficient means in the diagnosis of oral lesions of syphilis.

No período de março a maio de 2001, foram realizados os exames ultra-sonográficos em 88 ovelhas do Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia. Os animais foram examinados entre o 19°. e 33°. dia de gestação pela ultra-sonografia transretal com exames executados em dias alternados, e do 25°. ao 45°. dia pelo detector de prenhez para pequenos ruminantes (DPPR-80®). O diagnóstico foi considerado positivo pela ultra-sonografia transretal através da visualização do saco gestacional e embrião. Após o 25°. dia de gestação foi observado também o batimento cardíaco. Pelo detector de prenhez, a auscultação do batimento cardíaco embrionário, cuja freqüência é de 160 a 200 batimentos por minuto, foi dado como diagnóstico de gestação positivo. Dentre 88 fêmeas acasaladas, 3 abortaram durante o experimento e foram retiradas do grupo. Das 85 fêmeas restantes, 64 pariram. O diagnóstico de prenhez através da ultra-sonografia transretal apresentou 35,29% de acurácia no 19°.dia de gestação, culminando em 82,35% no 31°. dia de gestação. Pelo detector de prenhez, a acurácia foi de 24,71% no 25°.dia de gestação e 34,12% no 45°. dia. Foi possível visualizar os batimentos cardíacos do embrião pela ultra-sonografia transretal à partir do 21°. dia de gestação e os primeiros placentomas foram observados ao redor do 25°. dia de gestação. A ultra-sonografia transretal mostrou-se um método superior ao detector de prenhez para pequenos ruminantes, para diagnóstico precoce de gestação em ovelhas. / Ultrasonography was performed in 88 ewes from Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia, São Paulo state, from march to may, 2001. Animais were examined from 19°. to 33°. days of pregnancy by transrectal ultrasonography in alternate days examinations, and by pregnancy detector for small ruminants (DPPR-80®) from 25°. to 45°. day. Positive diagnostic by transrectal ultrasonography was obtained after yolk sac visualization. The embryo heartbeat was observed after 25 day of pregnancy. The positive diagnostic was obtained by pregnancy detector when embrionic heart rate was 160 to 200 beats/minute. Births confirmed the examinations. Three abortions occurred during the experiment and these females were excluded from the group. From 85 ewes examined, 64 lambed. The transrectal ultrasonography accuracy in 19°. day of pregnancy was 35,29%, with higher rate (82,53%) in 31°. day. The doppler accuracy in 25°. day was 24,71% and 34,12% in 45°. day. Embryo heartbeat was detected by transrectal ultrasonography after 21 days of pregnancy and the first placentoms were observed after 25 days of pregnancy. In conclusion, transrectal ultrasonography was better than doppler in early pregnancy diagnosis in sheep.

Introdução: Ainda que curável, a Tuberculose (TB) permanece no cenário epidemiológico mundial e nacional e parece estar distante de ser eliminada, uma vez que sua relação com as iniquidades sociais é inegável. Estima-se que, em 2015, 3 milhões de pessoas não tiveram a doença diagnosticada. O diagnóstico precoce é fundamental como uma estratégia preventiva para se evitar mortes e sofrimento, rompendo a cadeia de transmissão. No Município de São Bernardo do Campo-SP, a busca ativa de sintomáticos respiratórios tem se apresentado abaixo das metas estimadas. Objetivo: Elaborar um plano de intervenção para o aprimoramento da busca ativa de sintomáticos respiratórios no âmbito da Atenção Primária. Método: Trata-se de pesquisa-ação, realizada com 14 profissionais de saúde: coordenadores de unidade básica de saúde, médicos, enfermeiros, técnicos de enfermagem e agentes comunitários, representando um Território de Saúde do Município. À luz das diretrizes da Política Nacional da Atenção Básica e do Programa Nacional de Controle da Tuberculose, por meio de grupo focal, com sessões realizadas em 2016, a detecção precoce e a busca ativa de sintomáticos respiratórios foram problematizadas, tendo sido elaborado um plano de intervenção para reverter a situação de baixa busca ativa nas unidades básicas de saúde. Resultados: Os depoimentos dos participantes revelam que a TB ainda carreia estigma e preconceito, que dificultam a busca ativa de casos. Verificou-se que a busca ativa é expressivamente atribuída ao agente comunitário e não envolve outros membros da equipe; também se verificou a não utilização de espaços estratégicos na unidade de saúde para estimular a interação com a população e informá-la a respeito do agravo. Outro aspecto que emergiu refere-se ao diagnóstico da doença, realizado em unidades de pronto atendimento e de urgência e não no âmbito da atenção primária. Ademais, os profissionais de saúde reivindicam capacitação para a abordagem da TB, incluindo a incorporação de tecnologias leves na busca ativa. Elaborou-se um plano de intervenção com ações intra e extra-muros, além de indicar-se a necessidade de monitoramento dos indicadores epidemiológicos no âmbito institucional. Tratando-se de pesquisa-ação, algumas ações relacionadas à busca ativa de casos já tiveram início, envolvendo todas as unidades básicas de saúde. Conclusão: O plano de intervenção construído contribuirá para o controle da TB na região. Ainda assim, entende-se que o controle da doença requer intervenções amplas e que envolvem a qualificação dos profissionais de saúde, a participação da população e, sobretudo, políticas intersetoriais que modifiquem as condições sociais e de vulnerabilidade. / Introduction: Although curable, Tuberculosis (TB) remains in the worldwide and national epidemiological scenery and seems to be far from being eliminated, since its relationship with social inequalities is undeniable. It is estimated that in 2015, 3 million people did not have the disease diagnosed. The early diagnosis is essential as a preventive strategy to prevent deaths and suffering, breaking the transmission chain. In São Bernardo do Campo SP, the active search for respiratory symptoms has been shown below the estimated targets. Objective: To elaborate a plan of action to improve the active search for respiratory symptoms within the Primary Attention. Method: It is an action-research, performed with 14 health professionals: coordinators of basic health units, doctors, nurses, nursing technicians and community workers, representing a City Health Territory. In the light of the guidelines of the National Policy of Primary Attention and the National Program for Tuberculosis Control, through focus group, with sessions held in June of 2016, the question related to the early detection and active search for respiratory symptoms was questioned, having the plan of action been drawn up to reverse the situation in the basic health units. Results: The statements of the participants reveal that TB still carries stigma and prejudice, which hinder the active search for cases. It was found that the active search is significantly attributed to the community worker and does not involve other team members; there was also no use of the strategic spaces in the health unit to encourage interaction with the population and inform them about the grievance. Another aspect that has emerged concerns the diagnosis of the disease, conducted in emergency care and emergency units and not as part of the primary attention. In addition, health professionals claim training for TB approach, including the active search, mainly as regards the use of lightweight technologies. It was developed an intervention plan with intra and extramural actions, besides to indicate the need for monitoring epidemiological indicators at the institutional level. As an action-research, some actions related to the active search for cases already started, involving all basic health units. Conclusion: The intervention plan will contribute to the control of TB in the region, and it is understood that the control of the disease requires broad interventions, which involve the training of health professionals, public participation and, especially, intersectoral policies to modify social and vulnerability conditions.

Background: Bone metastases occur in most patients with advanced hormone-refractory prostate cancer causing pain, pathologic fractures, and spinal cord compression. Few studies specifically address surgical treatment of metastatic spinal cord compression (MSCC) in prostate cancer. Criteria for identifying patients who may benefit from surgery are poorly defined. Most of the current knowledge regarding tumor biology in prostate cancer is based on studies of primary tumors or soft tissue metastases. The mechanisms regulating growth of bone metastases are not fully established. Aims: a) to evaluate outcome after surgery for MSCC in prostate cancer and to identify prognostic factors for survival and functional recovery; b) to evaluate current practice for referral of prostate cancer patients with MSCC; c) to analyze expression of androgen receptor (AR), cell proliferation, apoptosis, and prostate-specific antigen (PSA) in bone metastases with regard to survival after surgery for complications of bone metastases. Patients and Methods: We retrospectively evaluated the hospital records of 68 consecutive patients operated for metastatic spinal cord compression. Tumor tissue from bone metastases was obtained on spinal surgery (54 patients), fracture surgery (4 patients) and biopsy (2 patients), and analyzed by immunohistochemistry. Results: Study I: Mortality and complication rate after surgery was high. Patients with hormone-naïve disease and those with hormone-refractory disease with good performance status and without visceral metastases had more favorable survival. The ability to walk after surgery was related to better survival. Study II: A new score for prognosis of survival after surgery for spinal cord compression includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The score is simple, tumor specific, and easy to apply in clinical practice. Study III: Our results suggest that delays in diagnosis and treatment may have negative impact on functional outcome. Pretreatment ability to walk, hormone status of prostate cancer, and time from loss of ambulation influenced neurological recovery after surgery for spinal cord compression. Study IV: High nuclear AR immunostaining in bone metastases and high preoperative serum PSA were associated with a poor outcome after metastasis surgery in patients with hormone-refractory prostate cancer. Short-term effect of castration therapy disclosed that nuclear AR immunostaining was decreased and apoptosis was increased, but cell proliferation remained largely unaffected. Conclusion:  Prostate cancer patients with metastatic spinal cord compression represent a heterogeneous group. We identified prognostic factors for survival and functional outcome, which may help clinicians in making decisions about treatment. Our results also implicate the need for development of local and regional guidelines for treatment of patients with spinal cord compression, as well as the importance of information to patients at risk.

Introduction: Early detection and case management remain the main strategies in malaria control programme (MCP) in a low endemic area such as in Java Island, Indonesia. These strategies require an understanding of the community’s care-seeking behaviour in relation to the various health services. Since most malaria cases in Java are diagnosed at home by the village malaria workers (VMWs), this study aimed to examine the user-provider interface in early detection and case management of malaria, particularly the interaction between the clinical malaria patients and the VMWs. Methods: The number of blood slides examined and the laboratory results over a 20-year period were retrieved from the routine malaria surveillance system. The population at risk of malaria and the rainfall data were obtained from secondary sources. In addition, age, sex, malaria species, types of drugs, drug and dosage and time lapse between slides taken and examined were recorded from the malaria registers at the three endemic health centres from 1994-1998. The quality of diagnosis was examined by re-reading 153 slides at the Faculty of Medicine, Gadjah Mada University. Prior to using rapid assessment procedures (RAP), we proposed 11 criteria and applied these to 15 published RAP studies in health. For each of the papers, two authors assessed the adequacy of information provided independently. Using the criteria as a guideline for developing a protocol, a RAP study of malaria was thereafter carried out. Data were retrieved from 38 free-listings, 28 in-depth interviews, seven focus group discussions and unstructured observation. A qualitative thematic content analysis was applied. Finally, based on the RAP results, a one-year longitudinal study of care-seeking behaviour of all clinical malaria cases treated by the VMWs was conducted in Mlonggo II area. Age, sex, daily actions and date of consultations were recorded by all VMWs in a diary that covered prior all contacts between the patients and the VMWs. Also, 24 interactions between the VMWs and the patients were audiotaped. Results: The incidence of malaria during the 1990s fluctuated, albeit at the lower level than that of the 1980s, and it reached a peak (3.5/1000 population) during an outbreak in 1996-97. There was no clear association between the El Nino phenomenon and incidence of malaria. The incidence was almost twice as high in children <15 years than in adults (15+ years). In <5 year old children the risk of P. vivax malaria was higher than the risk of P. falciparum. Comparisons between active and passive case detection (ACD and PCD) showed that almost 60% of 10, 493 confirmed malaria cases in Jepara were identified from ACD. ACD also detected significantly higher percentage of P. falciparum gametocyte infections than PCD (14.7% vs. 5.7%). The duration between slides taken to examination was however longer for ACD than for PCD (2.3 vs. 1.1 days). Applying the criteria to the published RAP studies, it was found that information was limited to address subjectivity, staff and ethics criteria. In Jepara, malaria (known as katisen or panas tis) was considered a common but minor illness. This was also reflected by the most common action taken by the patients, i.e. not doing anything. However, when the illness was perceived as important, the community had a good access to different health care providers. Eighty seven percent of cases had been treated by the VMWs on day four of the illness period. On day two, the proportion not treated was significantly higher in male than in female cases (60.7% and 54.6%; p 0.01) and in those <15 years of age compared with those 15+ years (71.3% and 56.9%; p<0.001). Insufficient understanding of malaria signs and symptoms likely leads to delay in illness recognition and treatment. Interactions between the VMWs and the patients were mostly focused on medical tasks, and low compliance with treatment was a common concern of the VMWs in the interaction. Conclusion: El Nino phenomenon was not associated with an epidemic in Jepara. A possible association between age and the risk of P. vivax malaria needs further investigation. In this decentralised health care system, ACD should be continued in a focus endemic area and therefore, efforts to retain the VMWs should be considered. This research showed similar findings between the RAP study and the longitudinal study. A consistent gap was found between the common understanding and the biomedical description of malaria. The performance of the VMWs supports the MCP through early contact with clinical malaria patients. Visits of VMWs within four days of symptom recognition appear to be the ideal situation for both the programme and the community. If case management continues to be the main strategy in MCP in this low endemic area, the emic perspective of the people must be well integrated to improve home treatment. Likewise, simple interventions to strengthen the role of VMWs in home management should be conducted.

Although Autism Spectrum Disorder (ASD) is considered to be a lifelong condition, some toddlers experience diagnostic instability over time. In particular, some toddlers’ diagnosis changes between ASD and Global Developmental Delay (GDD). However, little is known about the subset of children who change diagnosis. In a total of 424 toddlers who either maintained or changed diagnosis, the current study identified predictors of change in diagnosis and severity in those who change from ASD to non-ASD (ASD-NON), ASD to GDD (ASD-GDD), non-ASD to ASD (NON-ASD), and GDD to ASD (GDD-ASD) between two years old and four years old. Initial ASD symptom severity and participation in intervention services were predictive of all transitions. Additionally, receptive language predicted ASD-NON transition and socioeconomic status predicted ASD-GDD transition. Implications for informing prognosis of children, identifying targets of intervention, refining of screening and diagnostic measures, and measuring change in severity regardless of categorical change are discussed.

No description available.