480 research outputs found

    Laboratorial approach in the diagnosis of food allergy

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    OBJCTIVE: Review the available laboratory tests used to assist in the diagnosis of IgE-mediated and non-IgE-mediated food allergy. DATA SOURCES: Papers in English and Portuguese published in PubMed and Embase, in the last ten years. Terms searched were food allergy, diagnose and laboratory, isolated and/or associated. DATA SYNTHESIS: The diagnostic approach to food allergy reactions includes a good medical history, laboratory studies, elimination diets and blinded food challenges. More recently, the use of a quantitative measurement of food-specific IgE antibodies has been shown to be more predictive of symptomatic IgE-mediated food allergy. Food-specific IgE serum levels exceeding the diagnostic values indicate that the patient is greater than 95% likely to experience an allergic reaction if he/she ingests the specific food. Such decision point values have been defined just for some foods and inconsistent results were obtained when allergy to the same food was studied in different centers. Food challenges, in particular the double-blind placebo-controlled food challenge (DBPCFC), represent the most reliable way to establish or rule out food hypersensitivity. CONCLUSIONS: A number of recent developments are improving the predictive value of some laboratory tests for the diagnosis of food allergies. However, to date, no in-vitro or in-vivo test shows full correlation with clinical food allergy and the DBPCFC remains the gold standard for the definitive diagnosis of specific food allergies. There is an urgent need for new and fundamentally improved diagnostic approaches, which must be validated in patients with food allergy confirmed by a positive DBPCFC.OBJETIVO: Revisar os exames laboratoriais disponĂ­veis utilizados no diagnĂłstico da alergia alimentar mediada ou nĂŁo por IgE. FONTES DE DADOS: Artigos publicados em base de dados PubMed e Embase (lĂ­ngua inglesa e portuguesa) nos Ășltimos dez anos. As palavras-chave utilizadas como fonte de busca foram alergia alimentar, diagnĂłstico e laboratĂłrio, isolados e/ou associados. SÍNTESE DOS DADOS: A abordagem diagnĂłstica das reaçÔes alĂ©rgicas a alimentos inclui histĂłria clĂ­nica completa, estudos laboratoriais, dietas de eliminação e desencadeamentos cegos com alimentos. Recentemente, a medida quantitativa de anticorpos IgE especĂ­ficos a alimentos tem mostrado ser mais preditiva de alergia alimentar sintomĂĄtica mediada por IgE. NĂ­veis sĂ©ricos de IgE especĂ­fica a alimento que excedam os valores diagnĂłsticos indicam que o paciente tem chance maior que 95% de apresentar uma reação alĂ©rgica se ingerir o alimento em questĂŁo. Estes valores de decisĂŁo foram definidos para alguns alimentos e resultados inconsistentes sĂŁo obtidos ao se estudar diferentes populaçÔes. Os desencadeamentos com alimento, especialmente o duplo-cego controlado por placebo (DADCCP), representa a maneira mais confiĂĄvel de estabelecer ou descartar o diagnĂłstico de hipersensibilidade alimentar. CONCLUSÕES: NĂșmero crescente de aquisiçÔes tem melhorado o valor preditivo de alguns testes laboratoriais empregados no diagnĂłstico de alergias alimentares. Entretanto, atĂ© hoje, nĂŁo hĂĄ teste in vitro ou in vivo que mostre correlação completa com a clĂ­nica da alergia alimentar. O DADCCP continua sendo o padrĂŁo-ouro no diagnĂłstico definitivo de alergia alimentar especĂ­fica. SĂŁo necessĂĄrias, urgentemente, novas abordagens diagnĂłsticas vĂĄlidadas em pacientes com alergia alimentar confirmada por DADCCP positivo.Universidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUniversidade de SĂŁo Paulo Faculdade de Medicina Departamento de PediatriaUniversidade Federal da Bahia Departamento de PediatriaUNIFESP-EPMUniversidade Federal do ParanĂĄ Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPMSciEL

    Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

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    Background Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. Methods A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. Results This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Conclusion Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up.UKai
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