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- ItemAdded Value of QuantiFERON TB-Gold in-Tube for Detecting Latent Tuberculosis Infection among Persons Living with HIV/AIDS(BioMed Research International, 2014)Objective. To evaluate the added value of QuantiFERON TB-Gold in-Tube (QTF-GIT) over the tuberculin skin testing (TST) for detecting latent tuberculosis (TB) infection (LTBI) among patients with AIDS in a city with a low TB incidence rate (11.1/100,000 inhabitants) and universal BCG coverage. Methods. Three hundred consecutive patients with AIDS in eight outpatient sexually transmitted disease public clinics in Brasilia were submitted to QFT-IT and TST between May 2011 and March 2013. A positive result of either test was considered to be LTBI. Results. Median CD4-cell count was 477.5 cells/mm3 ; 295 (98.3%) were using antiretroviral therapy. Eighteen patients (6%, 95% CI: 3.6%–9.3%) had LTBI, of whom 4 (1.3%, 95% CI: 0.04%–2.63%) had only a positive TST, 8 (2.7%, 95% CI: 0.8%–4.5%) had only a QFT-GIT positive test, and 6 (2%, 95% CI: 0.4%–3.6%) had positive results for both tests. This represents an 81.8% relative increase in LTBI detection when QFT-GIT is added to TST. The concordance between both tests was 96% (k = 0.48). Conclusions. The QFT-GIT alone was more effective to detect LTBI than TST alone and had an 81% added value as an add-on sequential test in this population with mild immunosuppression. The cost-effectiveness of these strategies remains to be evaluated.
- ItemClassification and regression trees for predicting the risk of a negative test result for tuberculosis infection in Brazilian healthcare workers: a cross-sectional study(Rev Bras Epidemiol, 2021)Objectives: Healthcare workers (HCWs) have a high risk of acquiring tuberculosis infection (TBI). However, annual testing is resource-consuming. We aimed to develop a predictive model to identify HCWs best targeted for TBI screening. Methodology: We conducted a secondary analysis of previously published results of 708 HCWs working in primary care services in five Brazilian State capitals who underwent two TBI tests: tuberculin skin test and Quantiferon®-TB Gold in-tube. We used a classification and regression tree (CART) model to predict HCWs with negative results for both tests. The performance of the model was evaluated using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), cross-validated using the same dataset. Results: Among the 708 HCWs, 247 (34.9%) had negative results for both tests. CART identified that physician or a community health agent were twice more likely to be uninfected (probability = 0.60) than registered or aid nurse (probability = 0.28) when working less than 5.5 years in the primary care setting. In cross validation, the predictive accuracy was 68% [95% confidence interval (95%CI): 65 – 71], AUC was 62% (95%CI 58 – 66), specificity was 78% (95%CI 74 – 81), and sensitivity was 44% (95%CI 38 – 50). Conclusion: Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.
- ItemFatores e motivações associados à Escolha da Especialidade Pediatria(Revista Brasileira de educação Médica, 2014)Para entender a carência de pediatras em certas regiões do País, objetivamos identificar fatores asso- ciados à escolha da Pediatria e a intenção de retorno à cidade de origem. Aplicamos um questionário em uma universidade privada do Rio de Janeiro que usualmente tem metade dos estudantes de Medici- na oriundos de outros Estados. Analisaram-se associações entre escolha da Pediatria e características sociodemográficas, intenção de retorno à cidade de origem, influência de terceiros e motivações para a carreira médica, classificadas como “indispensabilidade”, “ajuda às pessoas”, “ser respeitado” e “interesse científico”. Dos 244 internos respondentes, 99 (41%) optaram pela Pediatria. Dos 110 na- turais de outros Estados, 56% dos que escolheram Pediatria não tinham intenção de retornar à cidade natal, comparados aos 35% na Clínica Médica (OR = 2,41, IC 95% = 1,04 - 5,59). As motivações “indispensabilidade” (rs = - 0,23; p < 0,000) e “respeito” (rs = - 0,21; p = 0,001) foram negativamente correlacionadas à escolha da Pediatria. O cenário alerta para a possível manutenção da má distribui- ção de pediatras no País e sugerimos medidas de incentivo ao retorno à cidade natal, já que motivações autocentradas movem menos os candidatos à especialidade.
- ItemEnsemble de especialistas para avaliação de adesão ao procedimento operacional padrão de fotografias de radiografias de tórax(Sociedade Brasileira de Inteligência Computacional, 2021)Sistemas de apoio ao diagnóstico baseados em inteligência computacional (computer-aideddiagnosis, CAD) para interpretação de imagens vêm sendo desenvolvidos e aplicados em diferentes especialidades médicas. A Organização Mundial da Saúde recomendou recentemente o uso de CAD para a detecção de tuberculose em radiografias de tórax (RxT). No contexto do desenvolvimento de um CAD, muitas vezes é necessário fotografar imagens de RxT. No entanto, para melhores resultados é preciso que as imagens sigam um padrão, por isso desenvolveu-se um procedimento operacional padrão (POP) para fotografá-las. O objetivo deste estudo é o de criar um modelo baseado em máquinas de comitê (ensemble) para avaliar se fotografias de RxT aderem ao POP e classificar eventuais desvios do POP, para então corrigi-los e usar as imagens para a triagem de tuberculose ativa no CAD. Uma base de dados composta por 783 fotografias de radiografias de tóraxcom diferentes desvios do POP foi dividida em 10 grupos, de acordo com os desvios.Um grupo controle era composto de imagens sem desvios do POP.Os desvios referiam-se ao uso de aplicativos, tripé e temporizador, resolução, luz do ambiente, cobertura total do espaço não ocupado do negatoscópio e centralização. Um modelo ensemble, baseado em especialistas, aliado a transfer learning e análise de componentes principais (PCA) foi projetado para identificar cada um dos grupos. As acurácias médias para detecção dos desvios foram superiores a 79%.
- ItemNon-completion of latent tuberculous infection treatment among children in Rio de Janeiro State, Brazil(INT J TUBERC LUNG DIS, 2016)BACKGROUND: Children with latent tuberculous in- fection (LTBI) are particularly vulnerable to progression to active tuberculosis (TB), and are thus a priority target for isoniazid preventive therapy (IPT). However, adher- ence to IPT is poor. We hypothesised that children from poorer families, with reduced access to health care and lack of understanding about the disease are more likely to default from IPT. METHODS: A questionnaire was administered to close child contacts or their parents at the time of prescribing IPT in three cities in Rio de Janeiro State. The children were followed prospectively. Treatment adherence was defined as taking 80% of prescribed doses. RESULTS: Among 1078 children screened for LTBI, 97 (8.9%) did not return for tuberculin skin test (TST) reading; 332 (30.8%) were TST-positive; 115/ 332 (34.6%) were prescribed IPT, 6 of whom did not initiate treatment and 11 did not adhere during the first 2 months; 25 additional children did not complete IPT. Overall non-completion was four times more frequent among those with lower income. Health care access and knowledge did not improve treatment completion. CONCLUSIONS: Substantial losses to follow-up oc- curred before IPT prescription; this should be further investigated. Among the children who started isoniazid, low income, but not difficult access or poor knowledge, increased the risk of treatment non-completion.