José Vilton Costa

Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy

The objective was to determine the cross-sectional area of the umbilical cord, its diameter and the diameter of its vessels to establish a reference curve for these parameters during pregnancy, through a prospective cross-sectional study, including 2,310 low-risk pregnancies between 12 and 40 weeks’ gestation. Means and standard deviations (SDs), plus the 10th, 50th and 90th percentiles for each measurement were calculated using polynomial regression analysis. Mann–Whitney, Kruskal–Wallis and Wilcoxon tests were used for statistical analysis. These parameters increased significantly with gestational age. The area of the cord also varied significantly with parity. Their new reference curves for low risk pregnancies were calculated using polynomial regression, and an almost linear increase in values was found up to 32 weeks of pregnancy, tending to stabilise from then onwards. The regression equation of the umbilical cord area according to gestational age (GA) was: –1.417 + 0.3026*GA–0.008*GA2 + 0.000007*GA3 and the degree of adjustment (R2) was 0.89.

Survival of Women With Cancer in Palliative Care: Use of the Palliative Prognostic Score in a Population of Brazilian Women

The objective of this study was to estimate the survival time of patients referred to the palliative care unit of the National Cancer Institute of Brazil (INCA), using the Palliative Prognostic (PaP) score, and thereby evaluate this tool in a location and population different from that in which the instrument was originally developed. In this prospective study, the instrument, after translation and adaptation to Brazilian Portuguese, was applied to 250 women consecutively referred to the palliative care unit of INCA, who had been followed up as outpatients between June 2005 and August 2006. The PaP score subdivided a heterogeneous population into three homogeneous risk groups with respect to survival time, and the differences between groups were statistically significant. The median overall survival time, calculated using the Kaplan-Meier method, for the three groups was 142 days (95% confidence interval [CI]: 118-172) for Group A, 39 days (95% CI: 28-52) for Group B, and nine days (95% CI: 1-24) for Group C. The percentage survival at 30 days for the three groups was 91.4%, 57.1%, and 0%, respectively. The longer survival time found in the first group in this study would appear to reflect the referral of patients in better clinical condition for outpatient follow-up in this institute. These data suggest that the PaP score is a consistent and easily applied instrument that allows more accurate prognostication in advanced cancer patients with no possibility of cure, irrespective of the geographical location.

Spatial distribution of dengue incidence and socio-environmental conditions in Campinas, São Paulo State, Brazil, 2007

This study aimed to analyze the spatial distribution of dengue risk and its association with socio-environmental conditions. This was an ecological study of the counts of autochthonous dengue cases in the municipality of Campinas, São Paulo State, Brazil, in the year 2007, aggregated according to 47 coverage areas of municipal health centers. Spatial models for mapping diseases were constructed with Bayesian hierarchical models, based on Integrated Nested Laplace Approximation (INLA). The analyses were stratified according to two age groups, 0 to 14 years and above 14 years. The results indicate that the spatial distribution of dengue risk is not associated with socio-environmental conditions in the 0 to 14 year age group. In the age group older than 14 years, the relative risk of dengue increases significantly as the level of socio-environmental deprivation increases. Mapping of socio-environmental deprivation and dengue cases proved to be a useful tool for data analysis in dengue surveillance systems.

Childhood enuresis is a risk factor for bladder dysfunction in adult life

To verify the relationship between enuresis in childhood and the type of urinary incontinence in adults, considering the gender and age.

Area of Wharton's jelly as an estimate of the thickness of the umbilical cord and its relationship with estimated fetal weight

BackgroundTo build a reference curve for the area of Whartons jelly (WJ) in low-risk pregnancies from 13 to 40 weeks and to assess its relationship with estimated fetal weight (EFW).Methods2,189 low-risk pregnancies had the area of WJ estimated by ultrasound and the 10th, 50th and 90th percentiles calculated using a third-degree polynomial regression procedure. EFW by ultrasound was correlated with the measurement of the area of WJ.ResultsThe area of WJ increased according to gestational age (R2 = 0.64), stabilizing from the 32nd week onwards. There was a significant linear correlation between area of WJ and EFW up to 26 weeks (R = 0.782) and after that 5t remained practically constant (R = 0.047).ConclusionThe area of WJ increases according to gestational age, with a trend to stabilize at around 32 weeks of gestation. It is also linearly correlated with EFW only up to 26 weeks of gestation.

Inter- and intra-observer variability in Sonographic measurements of the cross-sectional diameters and area of the umbilical cord and its vessels during pregnancy

BackgroundThe purpose of the study was to evaluate inter- and intra-observer variability in sonographic measurements of the cross-sectional area of the umbilical cord and the diameters of its vessels in low-risk pregnancies of 12 to 40 weeks of gestation.MethodsA prospective cross sectional study was performed in 221 pregnant women at different gestational ages. Measurements were carried out also by a second observer to evaluate inter-observer variability and repeated once again by the first observer to assess intra-observer variability. The linear correlation between the measurements (Spearmans coefficient of correlation) and their reliability through the intraclass correlation coefficient (ICC), the Cronbachs alpha coefficient and the limits of agreement proposed by Bland and Altman were evaluated.ResultsThe results showed that inter-observer and intra-observer variability did not show any significant difference between examiners. A good linear correlation between the measurements and reliability was obtained, with values of R, ICC and Cronbachs alpha all above the standard limits.ConclusionIt is possible to conclude that inter- and intra-observer variability in the measurements of the umbilical cord and its vessels was small; their reliability and agreement were good.

Validation study of the capacity of the reference curves of ultrasonographic measurements of the umbilical cord to identify deviations in estimated fetal weight

Background. The objective of this study was to evaluate the capacity of the cross‐sectional area and diameter of the umbilical cord, and the area of Whartons jelly (WJ), to predict abnormalities in estimated fetal weight (EFW) in 20–40 week, low‐risk pregnancies. Methods. A validation study was performed in 1,828 pregnant women. Fetal weight was estimated by ultrasonography and classified as: small for gestational age (SGA), appropriate for gestational age (AGA) or large for gestational age (LGA) according to the 10th and 90th percentiles of the reference curve. Measurements of the parameters of the cord were used to classify it as thin, normal or thick using the 10th and 90th percentiles of the reference curves as limits. The capacity of the diameter and total area of the cord and the area of WJ to predict abnormal EFW was calculated for different gestational ages. Results. The capacity of the diameter of thin cords to predict SGA fetuses (S =8.3%, PPV =16.5%) or thick cords to predict LGA fetuses (S =5.5%, PPV =30.1) was weak, similar to the capacity of the area of the umbilical cord to predict SGA (S =8.3%; PPV =16.3%) or LGA fetuses (S =5.5%; PPV =27.8%). The capacity of the area of WJ to predict SGA fetuses (S =5.7%, PPV =11.7%) was similar to its capacity to predict LGA fetuses (S =4%, PPV =27.1%). Conclusion. Despite the correlation between the diameter and cross‐sectional area of the cord and EFW, these measurements were not found to be useful in predicting alterations in EFW and should not be used for this purpose.

Saúde da mulher na imprensa brasileira: análise da qualidade científica nas revistas semanais

Este estudo, de corte transversal, avalia a qualidade cientifica de textos informativos sobre saude da mulher em revistas de circulacao nacional e descreve os temas abordados. Durante 12 meses consecutivos, foram coletados textos sobre saude da mulher nas principais revistas semanais brasileiras de atualidades: Veja, Epoca e Isto E. Foram selecionados oitenta textos, analisados de forma independente por dois medicos e dois jornalistas, por meio do questionario Index Of Scientific Quality, adaptado para o portugues e submetido a prova-piloto e reteste. O instrumento possui oito itens que variam de um a cinco pontos e medem: a aplicabilidade, opiniao versus fato, validade, alcance, precisao, coerencia, consequencia e um item global, que resume os outros itens e cuja mediana foi considerada para avaliacao. A mediana da qualidade cientifica dos textos referente ao item global foi igual a tres, demonstrando carater moderado em relacao as materias publicadas.

Women's health in the Brazilian press: analysis of scientific quality in weekly magazines

Este estudo, de corte transversal, avalia a qualidade cientifica de textos informativos sobre saude da mulher em revistas de circulacao nacional e descreve os temas abordados. Durante 12 meses consecutivos, foram coletados textos sobre saude da mulher nas principais revistas semanais brasileiras de atualidades: Veja, Epoca e Isto E. Foram selecionados oitenta textos, analisados de forma independente por dois medicos e dois jornalistas, por meio do questionario Index Of Scientific Quality, adaptado para o portugues e submetido a prova-piloto e reteste. O instrumento possui oito itens que variam de um a cinco pontos e medem: a aplicabilidade, opiniao versus fato, validade, alcance, precisao, coerencia, consequencia e um item global, que resume os outros itens e cuja mediana foi considerada para avaliacao. A mediana da qualidade cientifica dos textos referente ao item global foi igual a tres, demonstrando carater moderado em relacao as materias publicadas.

alud de la mujer en la prensa brasileña: análisis de calidad científica en las revistas semanales

Este estudo, de corte transversal, avalia a qualidade cientifica de textos informativos sobre saude da mulher em revistas de circulacao nacional e descreve os temas abordados. Durante 12 meses consecutivos, foram coletados textos sobre saude da mulher nas principais revistas semanais brasileiras de atualidades: Veja, Epoca e Isto E. Foram selecionados oitenta textos, analisados de forma independente por dois medicos e dois jornalistas, por meio do questionario Index Of Scientific Quality, adaptado para o portugues e submetido a prova-piloto e reteste. O instrumento possui oito itens que variam de um a cinco pontos e medem: a aplicabilidade, opiniao versus fato, validade, alcance, precisao, coerencia, consequencia e um item global, que resume os outros itens e cuja mediana foi considerada para avaliacao. A mediana da qualidade cientifica dos textos referente ao item global foi igual a tres, demonstrando carater moderado em relacao as materias publicadas.