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Este artigo foi modificado pela última vez em
23 de Abril de 2018.

Exames de triagem são usados para detecção de doenças comuns e potencialmente graves, como câncer, diabetes e doença cardíaca. Podem encontrar doenças em seus estágios iniciais e possivelmente curáveis, antes mesmo de aparecerem os sintomas. O médico pede exames de triagem com base na idade do paciente e em fatores de risco individuais.

O menu acima relaciona artigos sobre os exames sugeridos para adultos a partir de 50 anos de idade.

Para mais informações sobre medicina preventiva e sobre o que pode ser feito para manter as pessoas saudáveis, leia o artigo Mantendo-se saudável em uma era de responsabilidade do paciente.

Exames de triagem
  • Clamídia e gonorreia

    Clamídia e gonorreia são doenças bacterianas transmitidas sexualmente muito comuns, mas a maioria das pessoas infectadas não tem sintomas. Essas infecções em geral afetam a genitália, mas podem atingir outras membranas mucosas, olhos e articulações. Com frequência não causam sintomas, mas mesmo pessoas assintomáticas transmitem a infecção para seus parceiros sexuais. As duas são curadas com antibióticos. São comuns as reinfecções.

    A transmissão ocorre durante atividade sexual envolvendo a genitália, o ânus e a boca. O risco aumenta com o número de parceiros sexuais, como em todas a doenças transmitidas sexualmente, incluindo HIV/AIDS.

    Mulheres
    A Preventive Services Task Force, dos EUA, recomenda, para mulheres a partir dos 25 anos de idade:

    • Todas com atividade sexual, mesmo sem sintomas, mas que têm um risco aumentado de infecção, devem ser triadas para clamídia e gonorreia.

    A American Academy of Pediatrics, dos EUA, recomenda a repetição dos exames após relações sexuais com qualquer parceiro novo.

    A American College of Preventive Medicine, dos EUA, sugere para mulheres:

    • O profissional de saúde deve pesquisar fatores de risco em todas as consultas.
    • Deve ser feita uma pesquisa de clamídia por ano se houver fatores de risco.

    Grávidas
    A Preventive Services Task Force recomenda:

    • Deve ser feita pesquisa de clamídia em mulheres grávidas com mais de 25 anos de idade e com fatores de risco.
    • Se houver fatores de risco, deve ser feita uma pesquisa de gonorreia.

    Homens
    O profissional de saúde deve pesquisar fatores de risco em homens com atividade sexual. A triagem em geral não é feita em heterossexuais, embora eles possam se infectar e transmitir a doença.

    As recomendações do U.S. Centers for Disease Control and Prevention, dos EUA, para homens após relações sexuais com outros homens são:

    • Todos que mantêm relações sexuais com outros homens devem ser examinados pelo menos uma vez por ano para HIV, sífilis, gonorreia e clamídia, e ser vacinados para hepatite A e hepatite B.
    • É adequado fazer triagens a cada três a seis meses se o homem ou o parceiro apresentarem outros fatores de risco, como parceiros múltiplos e anônimos, ou usarem drogas ilícitas.

    Procure seu médico
    Embora seja possível ter uma doença transmitida sexualmente sem saber, alguns sinais e sintomas podem ser sugestivos e devem ser comunicados ao médico:

    • Micção dolorosa (com sensação frequente de queimação)
    • Corrimento vaginal
    • Corrimento uretral
    • Dor durante o ato sexual
    • Dor no abdome inferior
    • Dor nos testículos
    • Menstruação irregular
    • Dificuldade de engravidar

    Reinfecção
    Reinfecção é comum. Os exames devem ser repetidos três meses depois do tratamento.


    Links
    American Social Health Association: Learn about STDs/STIs


    Fontes

    American Academy of Family Physicians.  Chlamydia. July 2008. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/204.html through http://familydoctor.org. Accessed 8 Sept 2008.

    US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007: infectious diseases. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2b.htm through http://www.ahrq.gov. Accessed 17 Jan 2008.

    US Centers for Disease Control and Prevention. Prevent STDs among MSM. Available on the Internet at http://www.cdc.gov/ncidod/diseases/hepatitis/msm through http://www.cdc.gov. Accessed 23 Jan 2008.

    US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

    US Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. 4 Aug 2006. MMWR 55(RR11). Available on the Internet at http://www.cdc.gov/std/treatment through http://www.cdc.gov. Accessed 23 Jan 2008.

    US Preventive Services Task Force. Screening for chlamydial infection (recommendation statement). 17 Jul 2007. Ann Intern Med 17;147(2):128-34. Available on the Internet through http://www.guideline.gov. Accessed 23 Jan 2008.

    US Centers for Disease Control and Prevention. Chlamydia fact sheet. Last modified 20 Dec 2007. Available on the Internet at http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm through http://www.cdc.gov. Accessed 19 Jul 2004 and 23 Jan 2008. 

    Berg AO, for the US Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Apr 2001. Am J Prev Med 20(3 Suppl):90-94. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004; revision of 17 Jul 2007 accessed 17 Jan 2008.

    Hollblad-Fadiman K and Goldman SM, for the American College of Preventive Medicine. Screening for chlamydia trachomatis (practice policy statement). Apr 2003. Am J Prev Med 24(3):287-292. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004 and 18 Jan 2008.

    American Social Health Association. Gonorrhea (fact sheet). Available on the Internet through http://www.ashastd.org. Accessed 18 Jan 2008.

    Psychosocial factors—psychophysical factors: older adults (module 2). In: Reproductive Health Model Curriculum (2nd ed.). Association of Reproductive Health Professionals. Available on the Internet at http://www.arhp.org/curriculum/ModelCurriculum.cfm through http://www.arhp.org. Accessed 26 Feb 2008. 

  • Câncer de próstata

    O câncer de próstata é a terceira causa de morte de câncer em homens. Estudos prospectivos feitos em cadáveres mostram que a incidência dessa doença aumenta com a idade, e ocorre em mais de 80% dos homens que têm acima de 80 anos de idade. A maioria desses tumores, entretanto, é de crescimento lento e não chega a afetar a saúde ou a sobrevida das pessoas envolvidas.

    Os exames recomendados para triagem de câncer de próstata são o retal digital e a dosagem de antígeno prostático específico (PSA) no sangue. As autoridades divergem sobre a idade em que a triagem deve ser iniciada e sobre a frequência mais indicada.

    A American Cancer Society, dos EUA, recomenda a triagem anual de homens a partir de 50 anos de idade, usando os dois métodos. Apesar de um estudo recente não ter mostrado influência da triagem na mortalidade, casos específicos de tumores mais agressivos podem ser beneficiar do diagnóstico precoce, permitindo o tratamento nos estágios iniciais da doença.

     


    Links
    National Comprehensive Cancer Network
    Centers for Disease Control and Prevention: Prostate cancer screening decision guide
    Ottawa Health Research Institute: Decision Aids


    Fontes

    American Cancer Society. Cancer facts and figures 2008. Available on the Internet at http://www.cancer.org/docroot/stt/stt-).asp through http://www.cancer.org. Accessed 20 Feb 2008.

    Agency for Healthcare Research and Policy. Task Force Says Men Age 75 and Older Should Not Be Screened for Prostate Cancer. Available on the Internet at http://www.ahrq.gov/news/press/pr2008/tfproscanpr.htm through http://www.ahrq.gov. Issued August 4, 2008.

    Lin LS, Sherin K and the ACPM Prevention Practice Committee. Screening for prostate cancer in U.S. men (ACPM position statement). Feb 2008. Am J Prev Med 34(2):164-170. PDF available for download at http://www.acpm.org/ProstateScreening_AJPM.pdf through http://www.acpm.org. Accessed 21 Feb 2008.

    American Urological Association. Prostate cancer awareness for men. PDF available for download at http://www.auanet.org/guidelines/patient_guides/prostate_awareness.pdf through http://www.auanet.org. Accessed 21 Feb 2008.

    American Urological Association. Prostate-specific antigen best practice policy. Feb 2000. Oncology 14(2). Available on the Internet at http://www.cancernetwork.com/journals/oncology/o0002e.htm through http://www.cancernetwork.com. Accessed 5 Aug 2004 and 20 Feb 2008.

    Berg AO, for the US Preventive Services Task Force. Screening for prostate cancer: recommendations and rationale. 3 Dec 2002. Ann Intern Med 137(11):915-916. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004 and 20 Feb 2008.

    JAMA Patient Page: weighing difficult choices: treatment of prostate cancer. 16 Sep 1998. JAMA 280(11):1030. Available on the Internet at http://www.medem.com/medlb/articleslb.cfm?sub_cat=321 through http://www.medem.com. Accessed 5 Aug 2004; 15 Nov 2006 revision (JAMA 296:2402) accessed 20 Feb 2008.

    National Cancer Institute, National Institutes of Health. Prostate cancer (PDQ®): screening (summary of evidence). Available on the Internet at http://www.cancer.gov/cancertopics/pdq/screening/prostate/HealthProfessional through http://www.cancer.gov. 15 Dec 2003 version accessed 21 Jul 2004; 9 Jan 2008 version accessed 20 Feb 2008.

    National Cancer Institute, National Institutes of Health. Prostate cancer (PDQ®): screening. Available on the Internet at http://www.cancer.gov/cancertopics/pdq/screening/prostate/Patient through http://www.cancer.gov. 15 Dec 2003 version accessed 5 Aug 2004; 5 Oct 2007 version accessed 20 Jan 2008.

    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer early detection. Available on the Internet at http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection through http://www.nccn.org. Version 1.2004 accessed 5 Aug 2004; version 2.2007 accessed 20 Feb 2008.

    US Centers for Disease Control and Prevention. Prostate cancer screening: a decision guide. Available on the Internet at http://www.cdc.gov/cancer/prostate/publications through http://www.cdc.gov. Accessed 21 Jul 2004; update/review of 26 Sep 2006 accessed 20 Feb 2008.

    National Comprehensive Cancer Network. Prostate cancer treatment guidelines for patients. Available on the Internet at http://www.nccn.org/patients/patient_gls.asp through http://www.nccn.org. Accessed 5 Aug 2004; version vi (Oct 2007) accessed 20 Feb 2008.

    American Academy of Family Physicians. Prostate cancer: what you need to know. Available on the Internet at http://www.familydoctor.org/x5387.xml through http://www.familydoctor.org. Accessed 21 Jul 2004; Dec 2007 update accessed 20 Feb 2008.

    American College of Preventive Medicine. Screening for prostate cancer in American men: American College of Preventive medicine practice policy statement. 1998. Available on the Internet through http://www.medem.com. Accessed 5 Aug 2004 and 20 Feb 2008.

    Smith RA, Cokkinides V, Eyre HJ, for the American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin. 2003;53:27-43. Available on the Internet at http://caonline.amcancersoc.org/cgi/content/full/53/1/27 through http://caonline.amcancersoc.org. Accessed 5 Aug 2004.

    American College of Preventive Medicine. Understanding prostate cancer screening. 2001. Available on the Internet through http://www.medem.com. Accessed 21 Jul 2004 and 20 Feb 2008.

    US Centers for Disease Control and Prevention. Screening for prostate cancer (slide show and talking points). Available on the Internet at http://www.cdc.gov/cancer/prostate/publications/screening/slide_index.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 20 Feb 2008.

  • Tuberculose

    No Brasil, a tuberculose ainda é comum, especialmente em populações que vivem em aglomerações (como favelas e prisões), em usuários de drogas e em pessoas contaminadas com o vírus HIV. A vacinação com BCG é feita em todos os recém-nascidos com mais de 2 kg de peso, e pode ser repetida se o teste intradérmico permanecer negativo.

    Todas as pessoas em risco, porque convivem com quem têm tuberculose ou porque pertencem a grupos de risco, são avaliadas com o teste intradérmico (PPD) e com radiografias de tórax e outros exames. O teste intradérmico fornece uma medida da imunidade do indivíduo à tuberculose, conferida pela vacina ou por uma infecção assintomática anterior. Radiografias de tórax identificam lesões pulmonares ou linfonodos mediastínicos. A pesquisa e a cultura de bacilos álcool-ácido resistentes (BAAR) no escarro confirmam a doença.


    Links
    Centers for Disease Control and Prevention: TB Fact sheet


    Fontes

    US Centers for Disease Control and Prevention. QuantiFERON-TB Gold Test (fact sheet). Last modified 16 Nov 2007. Available on the Internet at http://www.cdc.gov/tb/pubs/tbfactsheets/QFT.htm through http://www.cdc.gov. Accessed 6 Dec 2007.

    US Centers for Disease Control and Prevention. Trends in Tuberculosis – United States, 2007. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm through http://www.cdc.gov.

    New Jersey Medical School and National Tuberculosis Center, University of Medicine and Dentistry of New Jersey. History of TB: the recent TB epidemic. 26 Feb 2001. Available on the Internet at http://www.umdnj.edu/globaltb/tbhistory.htm through http://www.umdnj.edu. Accessed 26 Jul 2004 and 6 Dec 2007.

    D’Alessandro D and Huth L. Children’s Virtual Hospital and The University of Iowa. Pediatrics common questions, quick answers: TB (tuberculosis). Last revised Apr 2002. Available on the Internet at http://lib.cpums.edu.cn/jiepou/tupu/atlas/www.vh.org/pediatric/patient/pediatrics/cqqa/tb.html through http://lib.cpums.edu.cn. Accessed 26 Jul 2004 and 6 Dec 2007.

    Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the advisory council for the elimination of tuberculosis. 8 Sep 1995. MMWR 44(RR11);18-34. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/00038873.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 28 Jan 2008.

    Targeted tuberculin testing and treatment of latent tuberculosis infection (American Thoracic Society/CDC statement). 9 Jun 2000. US Centers for Disease Control and Prevention. MMWR 49(RR06);1-54. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm through http://www.cdc.gov. Accessed 21 Jul 2004 and 6 Dec 2007.

    University of Iowa Health Care. Tuberculosis. Last modified 19 Oct 2006. Available on the Internet at http://
www.uihealthcare.com/topics/infectiousdiseases/infe4731.html through http://
www.uihealthcare.com. Last accessed 6 Dec 2007.

    Tuberculosis. In: Caring for Your Baby and Young Child: Birth to Age 5. 1999. Bantam. Excerpt on the Internet at http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ1BN54FDC&sub_cat=573 through http://www.medem.com. Accessed 26 Jul 2004 and 6 Dec 2007.

  • Obesidade

    A incidência de obesidade está aumentando em alguns países desenvolvidos, como os EUA, e afeta todas as faixas de idade, inclusive crianças.

    Para classificar o peso de uma pessoa, usa-se o índice de massa corporal (IMC), calculado com a fórmula:
    IMC = (peso em kg) ÷ (quadrado da altura em metros)
     
        IMC <18,5 : abaixo do normal
        IMC 18,5 – 24,9 : normal
        IMC 25,0 – 29,0 : sobrepeso
        IMC 30,0 – 39,9 : obesidade
        IMC  >40,0 : obesidade mórbida

    A obesidade é um problema de saúde porque aumenta o risco de diversas doenças, como hipertensão arterial, dislipidemias, diabetes do tipo 2, doença arterial coronariana, acidente vascular cerebral, cálculos biliares, osteoartrites, apneia do sono e problemas respiratórios.

    A U.S. Preventive Services Task Force, dos EUA, e outros órgãos recomendam:

    • O IMC de todos os adultos deve ser calculado periodicamente por um profissional de saúde.
    • Todos os adultos, com qualquer peso ou massa corporal, devem receber aconselhamento sobre os benefícios de dieta e atividade física adequadas.

    Links
    National Heart, Lung, and Blood Institute: Calculate your body mass index


    Fontes

    US Centers for Disease Control and Prevention. New CDC study finds no increase in obesity among adults; but levels still high. Nov 2007. Available on the Internet at http://www.cdc.gov/nchs/pressroom/07newsreleases/obesity.htm through http://www.cdc.gov. Accessed 11 Feb 2008.

    US Centers for Disease Control and Prevention. Prevalence of overweight among children and adolescents: United States, 2003-2004. Last reviewed 30 Jan 2007. Available on the Internet at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm through http://www.cdc.gov. Accessed 11 Feb 2008.

    National Center for Health Statistics. Prevalence of overweight and obesity among adults: United States, 2003-2004. Last reviewed 30 Jan 2007. Available on the Internet at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm through http://www.cdc.gov. Accessed 11 Feb 2008.

    American Academy of Family Physicians. Summary of policy recommendations for clinical preventive services. Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 11 Feb 2008.

    National Heart, Lung, and Blood Institute, National Institutes of Health. Calculate your body mass index. Available on the Internet at http://www.nhlbisupport.com/bmi. Accessed 23 Jul 2004 and 11 Feb 2008.

    Nawaz H and Katz KL. Weight management counseling of overweight adults: American College of Preventive Medicine practice policy statement. Jul 2001. Am J Prev Med 21(1):73-78. Available on the Internet at http://www.acpm.org/pol_practice.htm through http://www.acpm.org. Accessed 19 Jul 2004 and 11 Feb 2008.

    American Association of Family Physicians. Summary of policy recommendations for periodic health examinations. Aug 2003. Brief summary, on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

    US Preventive Services Task Force. Screening for obesity in adults: recommendation and rationale. 2 Dec 2003. Ann Intern Med 139(11):930-932. Available on the Internet at http://www.ahrq.gov/clinic/uspstf/uspsobes.htm through http://www.ahrq.gov. Accessed 19 Jul 2004 and 11 Feb 2008.

    Weise E. Medicare redefines obesity as medical. 15 Jul 2004 (updated 16 Jul 2004). USA Today. Available on the Internet at http://www.usatoday.com/news/washington/2004-07-15-medicare-obesity_x.htm through http://www.usatoday.com. Accessed 19 Jul 2004 and 11 Feb 2008.

  • Osteoporose

    A osteoporose é comum depois de 50 anos de idade, especialmente em mulheres após a menopausa. Sua principal complicação são fraturas ósseas por fragilidade, que ocorrem com maior frequência na coluna vertebral, no pulso e no fêmur. Quando ocorrem em idosos prejudicam a mobilidade e podem gerar dor crônica e outras complicações resultantes da imobilização prolongada.

    A National Osteoporosis Foundation, dos EUA, recomenda a triagem de adultos, através de densitometria óssea a cada dois anos, nos seguintes casos:

    • Homens com mais de 70 anos de idade.
    • Mulheres com mais de 65 anos de idade.
    • Adultos de meia-idade com fatores de risco, como fraturas anteriores, história familiar de osteoporose ou baixo peso corporal.

    O risco de osteoporose pode ser diminuído com alimentação adequada e alterações do estilo de vida, e se a pessoa já tem a doença, ela pode ser em parte compensada com essas medidas e com medicamentos.


    Links
    National Institutes of Health Osteoporosis and Related Bone Diseases: Check Up On Your Bones
    National Osteoporosis Foundation: Bone Tool Kit


    Fontes

    US Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general (2004). Available on the Internet at http://www.surgeongeneral.gov/library/bonehealth through http://www.surgeongeneral.gov. Accessed 19 Feb 2008.

    National Osteoporosis Foundation. Bone tool kit. 2007. PDF available for download at http://www.nof.org/awareness2/2007/images/Bone_Tool_Kit.pdf through http://www.nof.org. Accessed 19 Feb 2008.

    California Department of Health Services Osteoporosis Prevention and Education Program, Chronic Disease Control Branch. California’s action plan to prevent osteoporosis: 2005-2015. Available on the Internet at http://www.dhs.ca.gov/CDIC/cdcb/Medicine/Gerontology/OAUnit through http://www.dhs.ca.gov. Accessed 20 Feb 2008.

    National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. 2008. Available on the Internet at http://www.nof.org/professionals/Clinicians_Guide.htm through http://www.nof.org. Accessed 26 Feb 2008.

    World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom. FRAX WHO fracture risk assessment tool. Available on the Internet at http://www.shef.ac.uk/FRAX through http://www.shef.ac.uk. Accessed 26 Feb 2008.

    Amir Qaseem, MD, PhD, MHA et al. for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine 6 May 2008. Volume 148, Issue 9. Pages 680-684.

    National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. 2003. Available on the Internet at http://www.nof.org/physguide through http://www.nof.org. Accessed 19 Feb 2008.

    Raisz, LG. 14 Jul 2005. Screening for Osteoporosis. N Engl J Med 353;2:164-171. PDF available for download at http://www.temple.edu/iimreports/ReadingList/Miscscreening-for-Osteoporosis-NEJM-2005.pdf through http://www.temple.edu. Accessed 13 Mar 2008.

    Berg AO, for the US Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Jan 2003. Am J Nursing 103(1):73-80. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004 and 19 Feb 2008.

    National Osteoporosis Foundation. NOF applauds USPSTF recommendation on BMD tests (press release). 16 Sep 2002. Previously available on the Internet at http://www.nof.org/news/pressreleases/uspstf_02.html. Accessed 19 Jul 2004; document no longer posted.

  • Disfunção da tireoide

    Doenças da tireoide são relativamente comuns, e mais frequentes em mulheres que em homens.

    As opiniões sobre o valor de exames de triagem da tireoide (TSH, T4, T3) variam.

    A U.S. Preventive Services Task Force, dos EUA, fez uma revisão em 2004 e não obteve resultados conclusivos sobre benefícios da triagem de adultos assintomáticos.

    A American Thyroid Association, dos EUA, recomenda a triagem para pessoas acima de 35 anos de idade, especialmente mulheres, a cada cinco anos, ou em um intervalo menor se a pessoa apresentar sintomas.

    A American Association of Clinical Endocrinologists, dos EUA, recomenda a triagem para mulheres a partir de 50 anos de idade, ou mais cedo se houver uma história familiar de doença da tireoide.


    Links
    American Association of Clinical Endocrinologists (AACE): Thyroid Disease Fact Sheet
    AACE: Neck Check Card


    Fontes

    American College of Physicians. Inactive ACP guidelines. Available on the Internet at http://www.acponline.org/clinical_information/guidelines/past through http://www.acponline.org. Accessed 12 Feb 2008.

    Georgetown University Department of Medicine. Thyroid disease: basic thyroid information. Available on the Internet through http://www.medicine.georgetown.edu. Accessed 12 Feb 2008.

    National Women’s Health Resource Center. Thyroid disorders. 29 Sep 2002, reviewed 5 Mar 2007. Available on the Internet at http://www.healthywomen.org/healthtopics/thyroiddisorders through http://www.healthywomen.org. Accessed 12 Feb 2008.

    American Association of Clinical Endocrinologists. Women’s endocrine health. Available on the Internet at http://www.powerofprevention.com/w_endocrine.php through http://www.powerofprevention.com. Accessed 12 Feb 2008.

    American Association of Clinical Endocrinologists. 2004 thyroid awareness campaign encourages patients and physicians to take control of thyroid health (press release). 22 Jan 2004. Available on the Internet at http://www.aace.com/pub/press/release/index.php?r=20040122 through http://www.aace.com. Accessed 21 Jul 2004.

    American Association of Clinical Endocrinologists. Facts about thyroid disease. PDF available for download at http://www.aace.com/public/awareness/tam/2005/pdfs/thyroid_disease_fact_sheet.pdf through http://www.aace.com. Accessed 21 Jul 2004 and 12 Feb 2008.

    Goldsmith C. Hypothyroidism: easy to treat, often overlooked. 25 Feb 2002. Nurseweek News. Previously available on the Internet at http://www.nurseweek.com/ce/ce153a_print.html through http://www.nurseweek.com. Accessed 21 Jul 2004; document no longer posted.

    Ladenson PW, et al, for the American Thyroid Association. American Thyroid Association guidelines for detection of thyroid dysfunction. 12 Jun 2000. Arch Intern Med 60:1573-1575. PDF available for download at http://www.thyroid.org/professionals/publications/documents/GuidelinesdetectionThyDysfunc_2000.pdf through http://www.thyroid.org. Accessed 14 Jul 2004 and 12 Feb 2008.

    US Preventive Services Task Force. Screening for thyroid disease: recommendation statement. 20 Jan 2004. Ann Intern Med 140(2):125-127. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004 and 12 Feb 2008.

    American Association of Clinical Endocrinologists. Take control of your health: keep your thyroid in balance (patient brochure). PDF previously available for download at http://www.aace.com/pub/tam2004/PatientBrochure.pdf. Accessed 21 Jul 2004; document no longer posted.

    National Women’s Health Information Center, Office on Women’s Health, US Department of Health and Human Services. Thyroid disorders. Previously available on the Internet at http://www.4woman.gov/faq/thyroid_disease.htm. Accessed 15 Jul 2004; document no longer posted.

    American College of Physicians. Screening for thyroid disease (position paper). 1998. Ann Intern Med 129:141-143. Available on the Internet at http://www.annals.org. Accessed 21 Jul 2004.

    Helfand M and Redfern CC, for the American College of Physicians. Screening for thyroid disease: an update. 1998. Ann Intern Med 129:144-158. Available on the Internet at http://www.annals.org. Accessed 21 Jul 2004.

     

  • Câncer de mama

    O câncer de mama é uma causa importante de mortalidade em mulheres. Mamografias periódicas podem evitar muitas mortes ao detectar tumores em um a três anos antes que possam ser sentidos.

    A partir de 50 anos de idade:

    • A American Cancer Society, o American College of Obstetricians and Gynecologists, dos EUA, e outros órgãos recomendam uma triagem anual para mulheres com risco normal, a partir dos 40 anos de idade, incluindo exames das mamas feito por um profissional e mamografia.
    • A U.S. Preventive Services Task Force, dos EUA, recomenda que, para mulheres com risco normal e menos de 50 anos de idade, a triagem se baseie na história clínica e em fatores de risco; e, para mulheres com 50 a 74 anos de idade, a triagem inclua uma mamografia anual.

    A partir de 75 anos de idade:

    • A American Cancer Society, dos EUA, declara que a idade avançada não é uma razão para interromper a triagem de câncer de mama. Mulheres não portadoras de doenças graves devem continuar a rotina de exames das mamas feito por um profissional e mamografia.
    • A US Preventive Services Task Force, dos EUA, não encontrou evidências de benefícios adicionais na mamografia a partir de 75 anos de idade, e não faz recomendações específicas para essa faixa de idade.

    Essas recomendações se aplicam a pessoas sem fatores de risco conhecidos. Quando são identificados, deve ser iniciado um programa de triagem individual sob orientação médica. O link da American Cancer Society, abaixo, relaciona fatores que podem aumentar o risco de câncer de mama, incluindo predisposição genética e história familiar ou pessoal de câncer de mama.


    Links
    American Cancer Society: What are the risk factors for breast cancer?
    American Cancer Society: Can breast cancer be found early?
    To sign up for a personal mammogram scheduling reminder, click here.


    Fontes

    American Medical Women’s Association. Breast cancer screening. Revised 2000. Available on the Internet at http://www.amwa-doc.org/index.cfm?objectId=0AA0C8F2-D567-0B25-565A679EEA33CD7D through http://www.amwa-doc.org. Accessed 7 Feb 2008.

    American Cancer Society. Detailed guide: breast cancer—can breast cancer be found early? Revised 13 Sep 2007. Available on the Internet at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=5 through http://www.cancer.org. Accessed 7 Feb 2008.

    American Cancer Society. Breast cancer: early detection.  Available on the Internet at http://www.cancer.org/docroot/cri/content/2_6x_breast_cancer_early_detection.asp through http://www.cancer.org. Accessed 15 Jul 2004 and 7 Feb 2008.

    National Women’s Health Information Center, US Department of Health and Human Services. General screenings and immunizations for women. Material posted as of Nov 2007. Available on the Internet at http://www.4women.gov/screeningcharts/general through http://www.4women.gov. Accessed 4 Feb 2008.

    US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2c.htm through http://www.ahrq.gov. Accessed 4 Feb 2008.

    American Academy of Family Physicians. Summary of recommendations for clinical preventive services (rev 6.4). 15 Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 4 Feb 2008.

    US Centers for Disease Control and Prevention. Women’s health—facts and stats—selected US national research findings—cancer. 2004. Available on the Internet at http://www.cdc.gov/women/natstat/cancer.htm#breast through http://www.cdc.gov. Accessed 7 Feb 2008.

    Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Breast cancer: the most common malignancy in women. Spring 2004. Prevention Report 18(3). Available on the Internet at http://odphp.osophs.dhhs.gov/PUBS/prevrpt/04Volume18/Issue3pr.htm through http://odphp.osophs.dhhs.gov. Accessed 7 Feb 2008.

    American College of Radiology. Breast care guidelines (press release). Nov 2000.

    US Centers for Disease Control and Prevention. The National Breast and Cervical Cancer Early Detection Program—reducing mortality through screening (2003 program fact sheet). Revised May 2004. Available on the Internet at http://www.cdc.gov/cancer/nbccedp/about.htm through http://www.cdc.gov. Accessed 15 Jul 2004.

    US Preventive Services Task Force. Screening for breast cancer: recommendations and rationale (release date Feb 2002). 3 Sep 2002. Ann Intern Med 137(5 Part 1):344-346. Available on the Internet at http://www.ahcpr.gov/clinic/uspstf/uspsbrca.htm through http://www.ahcpr.gov. Accessed 15 Jul 2004 and 7 Feb 2008.

    US Centers for Disease Control and Prevention.  Healthy People 2010, increase proportion receiving mammogram objective 3.13. Available on the Internet at http://www.healthypeople.gov/document/html/objectives/03-13.htm through http://www.healthypeople.gov. Accessed 15 Jul 2004 and 7 Feb 2008.

    US Centers for Disease Control and Prevention. Table 80: use of mammography for women 40 years of age and over according to selected characteristics: United States, selected years 1987-2000. Health, United States 2003. Available on the Internet at http://www.cdc.gov/nchs/products/pubs/pubd/hus/womens.htm through http://www.cdc.gov. Accessed 6 Aug 2004.

    Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Annals of Internal Medicine. November 17, 2009 vol. 151 no. 10 716-726. Available online at http://www.annals.org/content/151/10/716.full through http://www.annals.org. Accessed November 2009.

     

  • Câncer de colo do útero

    A maioria das mortes por câncer do colo do útero (a parte inferior do útero) pode ser evitada com triagens regulares usado o método de Papanicolaou. Esse tipo de câncer, observado em geral em mulheres com mais de 40 anos de idade, é de desenvolvimento lento. Triagens de rotina podem identificar a doença em seus estágios iniciais, quando ele é curável na maior parte dos casos, e até lesões pré-cancerosas, que podem ser removidas com facilidade.

    Além do teste de Papanicolaou, recomenda-se a pesquisa de DNA de papilomavírus (HPV). Infecções persistentes com algumas cepas de HPV são um fator de risco importante de câncer de colo do útero. Dois tipos de HPV, 16 e 18, correspondem a cerca de 70% dos casos de câncer cervical nos EUA.

    A American Cancer Society, a U.S. Preventive Services Task Force, o American College of Obstetricians and Gynecologists, e a American Academy of Family Physicians, dos EUA, têm recomendações semelhantes para mulheres com mais de 30 anos de idade e com atividade sexual:

    • A partir dos 30 anos de idade, mulheres sem fatores de risco conhecidos e com resultados de Papanicolaou e pesquisa de DNA de HPV normais durante três anos sucessivos devem repetir os dois exames a cada três anos.

    A frequência dos exames pode ser maior quando há fatores de risco identificados, como exposição ao dietilestilbestrol, comportamento sexual de risco, HIV ou comprometimento do sistema imunológico. Mulheres submetidas a histerectomia em geral devem fazer os exames, porque o colo do útero é preservado na maioria dos casos.

    O American College of Obstetricians and Gynecologists, dos EUA, recomenda um exame pélvico anual, mesmo quando não é necessário o teste de Papanicolaou.


    Links
    To sign up for a personal Pap test scheduling reminder, click here.


    Fontes

    (December 2009). American College of Obstetricians and Gynecology Practice Bulletin Number 109, Cervical Cytology Screening. PDF available for download at http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf through http://journals.lww.com. Accessed December 2009.

    American Cancer Society. DES Exposure: Questions and Answers. Available online at http://www.cancer.org/docroot/CRI/content/CRI_2_6x_DES_Exposure_Questions_and_Answers.asp through http://www.cancer.org. Accessed September 2008.

    American College of Obstetricians and Gynecologists. Cervical cancer screening: testing can start later and occur less often under new ACOG recommendations (press release). 31 Jul 2003. Available on the Internet at http://www.acog.org/from_home/publications/press_releases/nr07-31-03-1.cfm through http://www.acog.org. Accessed 15 Jul 2004 and 18 Jan 2008.

    American College of Physicians. New pap guidelines reduce screening, but raise concerns about compliance. Apr 2003. Observer. Available on the Internet at http://www.acponline.org/journals/news/apr03/pap_guides.htm?hp through http://www.acponline.org. Accessed 15 Jul 2004 and 18 Jan 2008.

    American College of Obstetricians and Gynecologists. Human papillomaviruses and cancer: questions and answers. 8 Jun 2006. Available on the Internet through http://www.medem.com. Accessed 18 Jan 2008.

    American College of Obstetricians and Gynecologists. Cervical cytology screening (practice bulletin 45). Aug 2003.  Available on the Internet at http://www.guideline.gov. Accessed 8 Feb 2008.

    American Society for Colposcopy and Cervical Pathology. What women should know about HPV and cervical health. 2003. Available on the Internet at http://www.asccp.org/patient_edu.shtml through http://www.asccp.org. Accessed 17 Jan 2008.

    American Academy of Family Physicians. Summary of recommendations for clinical preventive services (rev 6.4). 15 Aug 2007.  Available on the Internet at http://www.guideline.gov. Accessed 4 Feb 2008.

    American Cancer Society. American Cancer Society guidelines for the early detection of cancer. 28 Mar 2007.  Available on the Internet at http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED through http://www.cancer.org. Accessed 4 Feb 2008.

    American Cancer Society. Overview: cervical cancer: What causes cancer of the cervix? Can it be prevented? Available on the Internet at http://www.cancer.org. Accessed 10 Aug 2004; 2006 revision accessed 8 Feb 2008.

    American Society for Colposcopy and Cervical Pathology. Descriptions of new FDA-approved HPV DNA tests (clinical update). PDF available for download at http://www.asccp.org/pdfs/consensus/clinical_update_20090408.pdf through http://www.asccp.org. Accessed 11 Jun 2009.

    National Cancer Institute. Human papillomaviruses and cancer: questions and answers (fact sheet). Available on the Internet at http://www.cancer.gov/cancertopics/factsheet/Risk/HPV through http://www.cancer.gov. Accessed 9 July 2009.

    Smith RA, Cokkinides V, and Eyre HJ, for the American Cancer Society. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 53:27-43. Available on the Internet at http://caonline.amcancersoc.org/cgi/content/full/53/1/27 through http://caonline.amcancersoc.org. Accessed 5 Aug 2004 and 8 Feb 2008.

    Solomon D, Papillo J, Davey D, on behalf of the Cytopathology Education and Technology Consortium. Statement on HPV DNA Test Utilization. Am J Clin Pathol 2009;131:768-769.

    US Centers for Disease Control and Prevention. Basic facts on screening and the Pap test. Oct 2003. PDF available for download at http://www.cdc.gov/cancer/cervical/pdf/cc_basic.pdf through http://www.cdc.gov. Accessed 2 Aug 2004 and 18 Jan 2008.

    US Preventive Services Task Force. Screening for cervical cancer (release date Jan 2003). Available on the Internet at http://www.ahcpr.gov/clinic/uspstf/uspscerv.htm through http://www.ahcpr.gov. Accessed 15 July 2004 and 8 Feb 2008.

    US Preventive Services Task Force.  Screening for cervical cancer: recommendations and rationale (AHRQ pub. 03-515A). Jan 2003. Available on the Internet at http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm through http://www.ahrq.gov. Accessed 8 Feb 2008.

    US Food and Drug Administration. Cervical Cancer Screening. FDA Consumer Magazine. January-February 2004. Available online at http://www.fda.gov/Fdac/features/2004/104_cancer.html through http://www.fda.gov. Accessed September 2008.

  • Câncer colorretal

    Muitas mortes por câncer colorretal poderiam ser evitadas com triagens regulares. Essa doença é a terceira causa mais frequente de morte por câncer no mundo. A triagem permite identificar lesões pré-cancerosas (pólipos, adenomas) e lesões cancerosas iniciais, ainda com uma grande probabilidade de cura.

    A maioria das recomendações recomenda a triagem de adultos a partir de 50 anos de idade, mas não há um consenso sobre o método mais indicado. Os que estão disponíveis incluem exames laboratoriais das fezes, exames endoscópicos e radiológicos:

     

    • A pesquisa de sangue oculto nas fezes pode reduzir em 15% a 33% as mortes por câncer colorretal. É feita por métodos químicos ou imunoquímicos em uma ou mais amostras de fezes.
    • A pesquisa de DNA nas fezes identifica sequências características de carcinomas nas células que descamam do tubo digestivo. É um exame recente e seu valor na triagem ainda não está determinado.
    • A retossigmoidoscopia é um método endoscópico que permite a visualização do reto e da parte terminal do cólon. Durante o exame, lesões pré-cancerosas e cancerosas podem ser identificadas e removidas ou biopsiadas. É necessária a limpeza do cólon antes do exame, usando medicamentos catárticos.
    • A colonoscopia difere da sigmoidoscopia porque permite examinar todo o cólon e o reto. É considerada mais sensível para identificar lesões, permitindo também retirada ou biópsia das lesões observadas. É necessário fazer a limpeza do cólon antes do exame, usando medicamentos catárticos. Durante o exame, a maioria dos pacientes recebe alguma forma de sedação.
    • A colonoscopia virtual é um método radiológico que envolve o processamento de imagens de tomografia computadorizada para reconstituir todo o trajeto do cólon em imagens a duas e três dimensões, permitindo a identificação de lesões. É necessária a limpeza do cólon antes do exame, usando medicamentos catárticos. As lesões identificadas devem ser retiradas ou biopsiadas em seguida durante uma colonoscopia.
    • O clister opaco é outro método radiológico usado para pesquisar lesões no cólon. Após limpeza com catárticos, o cólon é enchido com um contraste de bário e ar. O exame permite detectar de 30% a 50% dos tumores identificados na colonoscopia. As lesões identificadas devem ser retiradas ou biopsiadas em seguida durante uma colonoscopia.

    O médico e o paciente devem escolher o método mais conveniente em cada momento. A pesquisa de sangue oculto é um exame simples, que pode ser feito a cada ano ou com mais frequência. A colonoscopia é o mais sensível, mas envolve preparo do intestino, sedação e um custo maior, e pode ser recomendada a cada cinco anos.


    Links
    MedlinePlus: Colorectal Cancer
    Healthwise, Inc. Decision Point: Which test should I have to screen for colorectal cancer?
    To use a calculator to determine your risk, click here.
    To sign up for a personal colon cancer screening reminder, click here.


    Fontes

    Bernard L, et al. 5 Mar 2008 (e-pub). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58. Available on the Internet through http://caonline.amcancersoc.org. Accessed 6 Mar 2008.

    Boyles, S. 6 Mar 2008. Flat lesions linked to colon cancer: flat lesions can be overlooked during colonoscopies. Available on the Internet at http://www.webmd.com/colorectal-cancer/news/20080306/flat-lesions-linked-to-colon-cancer?src=RSS_PUBLIC through http://www.webmd.com. Accessed 14 Mar 2008.

    American Cancer Society. Can colorectal polyps and cancer be found early? American Cancer Society colorectal cancer screening guidelines. Rev 5 Mar 2008. Available on the Internet through http://www.cancer.org. Accessed 14 Mar 2008.

    US Centers for Disease Control and Prevention. Colorectal cancer screening guidelines. Reviewed/updated 16 Feb 2007. Available on the Internet at http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm through http://www.cdc.gov. Accessed 15 Feb 2008.

    Jemal, A, et al. Mar/Apr 2008. Cancer statistics, 2008. CA Cancer J Clin 58:71-96. Available on the Internet at http://caonline.amcancersoc.org/cgi/content/full/58/2/71 through http://caonline.amcancersoc.org. Accessed 14 Mar 2008.

    US Centers for Disease Control and Prevention. United States cancer statistics: major facts and findings. Updated/reviewed 24 Sep 2007. Available on the Internet at http://www.cdc.gov/cancer/npcr/uscs/2004/facts_major_findings.htm through http://www.cdc.gov. Accessed 15 Feb 2008.

    US Centers for Disease Control and Prevention. A call to action: colorectal cancer (talking points, slides 35 and 37). Available on the Internet at http://www.cdc.gov/cancer/colorctl/caltoaction/slide_index.htm through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

    Centers for Medicare and Medicaid Services, US Department of Health and Human Services. Colorectal cancer facts for people with Medicare (pub. 11040). PDF available for download at http://www.medicare.gov/publications/pubs/pd/11040.pdf through http://www.medicare.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

    US Centers for Disease Control and Prevention. Colorectal cancer: health professionals facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_professional.htm through http://www.cdc.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

    US Centers for Disease Control and Prevention. Colorectal cancer: Screen For Life: basic facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_basic.htm through http://www.cdc.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

    American Gastroenterological Association. Colorectal cancer screening (patient brochure). Previously available on the Internet at http://www.gastro.org/clinicalRes/brochures/cc_screening.html. Accessed 15 Jul 2004; document no longer posted.

    Centers for Medicare & Medicaid Services, US Department of Health and Human Services. Colorectal cancer screening for people with Medicare (pub. 11039). 1 Apr 2003 (since revised: Jan 2006). Available on the Internet at http://www.cdc.gov/cancer/colorectal/sfl/print_materials.htm through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

    American Cancer Society. Guidelines for the early detection of colon cancer (reviewed 2003). PDF available for download at http://www.cancer.org/colonmd/pdfs/guidelines.pdf through http://www.cancer.org. Accessed 15 Jul 2004.

    New recommendations by the American College of Gastroenterology call for changes in colorectal cancer screening of African Americans (press release). 21 Mar 2005. Available on the Internet at http://www.acg.gi.org/media/releases/march212005.asp through http://www.acg.gi.org. Accessed 2005 and 14 Feb 2008.

    Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? 19 Mar 2003. JAMA 289:1414-1420.

    Stevens T and Burke CA. Colonoscopy screening in the elderly: when to stop? Aug 2003. Amer J Gastroenterol 98;8:1881. Available on the Internet through http://www.amjgastro.com. Accessed 3 Aug 2004; abstract accessed 14 Feb 2008.

    US Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged 50 years, United States, 2001. 14 Mar 2003. MMWR 52(10). PDF available for download at http://www.cdc.gov/MMWR/PDF/wk/mm5210.pdf through http://www.cdc.gov. Accessed 3 Aug 2004 and 14 Feb 2008.

    US Preventive Services Task Force. Screening for colorectal cancer: recommendations and rationale. 2002. Ann Intern Med 137(2):129-31. Available on the Internet at http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm through http://www.ahrq.gov. Accessed 15 Jul 2004 and 14 Feb 2008.

    Winawer S, et al, for the US Multi-Society Task Force on Colorectal Cancer. Colorectal cancer screening and surveillance: clinical guidelines and rationale, update based on new evidence. Feb 2003. Gastroenterol 124(2):544-560. Available on the Internet at http://www.guideline.gov. Accessed 19 Jul 2004 and 14 Feb 2008.

    JournalWatch. "USPSTF Updates Colorectal Cancer Screening Guidelines." Availabe online at http://firstwatch.jwatch.org/cgi/content/short/2008/1007/1?rss=1 through http://firstwatch.jwatch.org. Accessed November 2008.

    U.S. Preventive Services Task Force. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine Volume 149, Issue 9. November 4, 2008. Available online at http://www.annals.org/cgi/content/full/0000605-200811040-00243v1 through http://www.annals.org. Accessed November 2008.

  • Diabetes do tipo 2

    A Organização Mundial de Saúde avalia que pelo menos 171 milhões de pessoas no mundo têm diabetes. No Brasil, são 7,6 milhões. A incidência de diabetes em todo o mundo está aumentando e deve dobrar até 2030. Além disso, existem muitos milhões de pessoas que têm diabetes e não sabem ou que têm pré-diabetes. O diagnóstico de pré-diabetes permite retardar ou impedir o desenvolvimento do diabetes do tipo 2 e suas complicações vasculares, com consequências para os olhos, os rins, os nervos e o coração. Contribuem para a doença a obesidade e a falta de atividade física.

    Muitas das orientações atuais de triagem recomendam triagem seletiva para diabetes melito. Por exemplo, o National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), dos EUA, recomenda a triagem a partir de 45 anos de idade em pessoas que têm peso excessivo e um ou mais fatores de risco (ver abaixo), usando a glicemia em jejum ou a glicemia pós-prandial.

    A triagem deve ser repetida a cada três anos, ou mais cedo quando houver peso excessivo ou fatores de risco adicionais.

    Fatores de risco

    Familiares:

    • Parentes próximos com diabetes.

    Pessoais:

    • Peso acima do normal e vida sedentária.
    • Hipertensão arterial, doença cardíaca ou vascular.
    • Exames anteriores que sugerem intolerância à glicose.

    Em mulheres:

    Embora a U.S. Preventive Services Task Force, dos EUA, relatasse, em 2003, que não podia determinar as vantagens da triagem universal, ela recomenda fazer em adultos com hipertensão arterial ou níveis de colesterol altos.


    Links
    NIDDK: Am I at Risk for Type 2 Diabetes?
    NHLBI: Calculate Your Body Mass Index
    To sign up for a personal diabetes test scheduling reminder, click here.


    Fontes

    ACE/AACE Diabetes Road Map Task Force. Road maps to achieve glycemic control in type 2 diabetes mellitus. May/Jun 2007. Endocr Pract 13:260-268. PDF available for doanload at http://www.aace.com/meetings/consensus/odimplementation/roadmap.pdf through http://www.aace.com. Accessed 18 Feb 2008.

    American Diabetes Association. Standards of medical care in diabetes—2008 (position statement). Jan 2008. Diabetes Care 31:S12-S54 Available on the Internet through http://www.care.diabetesjournals.org. Accessed 18 Feb 2008.

    National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health. National diabetes statistics (NIH pub. 06–3892). Nov 2005. Available on the Internet at http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm#12 through http://diabetes.niddk.nih.gov. Accessed 19 Feb 2008.

    U.S. Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 Jun 3; 148:846. [Erratum in: Ann Intern Med 2008 Jul 15; 149:147.]

    US Centers for Disease Control and Prevention. Number of Americans with diabetes continues to increase (fact sheet). 26 Oct 2005. Available on the Internet at http://www.cdc.gov/od/oc/media/pressrel/fs051026.htm through http://www.cdc.gov. Accessed 5 Mar 2008.

    National Institute for Diabetes and Digestive Kidney Diseases, National Institutes of Health. Am I at risk for type 2 diabetes? (NIH pub. 04-4805). Apr 2004. Available on the Internet at http://www.diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm#4 through http://www.diabetes.niddk.nih.gov. Accessed 19 Jul 2004; revision of Dec 2006 accessed 15 Feb 2008.

    American Diabetes Association. Screening for type 2 diabetes. Jan 2004. Diabetes Care 27:S11-14. Brief summary available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

    National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, US Centers for Disease Control and Prevention. CDC statements on diabetes issues: screening for type 2 diabetes. 18 Jun 2004. Available on the Internet at http://www.cdc.gov/diabetes/news/docs/screening.htm through http://www.cdc.gov. Accessed 19 Jul 2004 and 15 Feb 2008.

    Matfin G and Guven S. Diagnosing Diabetes Mellitus: do we need new criteria? Available on the Internet, from the American Association of Clinical Endocrinologists, at http://www.aace.com/clin/fcc/fcc-200001.php through http://www.aace.com. Accessed 19 Jul 2004.

    Mayer-Davis EJ, D’Antonia A, Tudor-Locke C. Lifestyle for diabetes prevention. In: Diabetes in the Life Cycle and Research: A Core Curriculum for Diabetes Education (5th ed.). Franz MJ, ed. American Association of Diabetes Educators. 2003; page 3.

    US Preventive Services Task Force. Screening for Diabetes Mellitus, adult type 2. Feb 2003. Available on the Internet at http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm through http://www.ahrq.gov. Accessed 19 Jul 2004 and 15 Feb 2008.

    Sherwin RS, et al. Prevention or delay of type 2 diabetes. Jan 2004. Diabetes Care 27:S47-S54. Available on the Internet through http://care.diabetesjournals.org. Accessed 19 Jul 2004 from the National Guideline Clearinghouse and 15 Feb 2008.

  • Colesterol alto

    A partir da infância, colesterol e outras substâncias gordurosas se acumulam nas artérias. Com o tempo, isso forma placas que estreitam as artérias em todo o corpo, em um processo chamado aterosclerose. A principal causa de morte nos países desenvolvidos é a doença coronariana, que está relacionada com os níveis sanguíneos de colesterol.

    O National Cholesterol Education Program e a American Heart Association, dos EUA, recomendam a triagem de lipídios no sangue a partir do início da idade adulta:

    • A cada 5 anos, todos os adultos com mais de 20 anos de idade devem fazer um perfil lipídico após jejum. Se os níveis estiverem normais diversas vezes, o intervalo entre os exames pode aumentar. Se os resultados forem limítrofes, o intervalo deve diminuir.

    Após 9 a 12 horas em jejum, são medidos no sangue: colesterol total, colesterol HDL, colesterol LDL e triglicerídeos. Sem jejum, apenas duas medidas podem ser feitas: colesterol total e colesterol HDL.

    Outros órgãos, que são menos rigorosos, recomendam:

    • Triagem de distúrbios lipídicos em todos os homens a partir de 35 anos de idade e em todas as mulheres a partir de 45 anos.
    • Exames de adultos mais jovens devem ser feitos quando há outros fatores de risco de doença coronariana.

    Esses fatores de risco são fumo, hipertensão arterial (140/90 mm Hg ou uso de medicamentos anti-hipertensivos), diabetes, obesidade, história familiar de doença coronariana precoce, nível baixo de colesterol HDL ou nível alto de colesterol LDL. Quem apresenta dois ou mais fatores de risco deve ser acompanhado com maior frequência.

    Sobre o limite de idade para o exame, a U.S. Preventive Services Task Force, dos EUA, recomenda:

    • Após 65 anos, não há necessidade de fazer exames, porque os níveis de lipídicos não costumam aumentar nessa idade. Entretanto, pessoas que nunca fizeram um exame devem ser testadas pelo menos uma vez.

    Links
    University of Maryland Heart Center: Heart Disease Risk Calculator
    National Heart, Lung, and Blood Institute: What is high blood cholesterol?
    American Academy of Family Physicians: Heart disease & Stroke
    To sign up for a personal cholesterol test scheduling reminder, click here.


    Fontes

    American Academy of Family Physicians. Summary of policy recommendations for clinical preventive services. Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 11 Feb 2008.

    American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood (policy statement). Jan 1998 (retired 1 May 2006). Pediatrics 101:1;141-147. Available on the Internet through http://aappolicy.aappublications.org. Accessed 10 Aug 2004.

    Berg AO, for the US Preventive Services Task Force. Screening for lipid disorders: recommendations and rationale. Apr 2001. Am J Prev Med 20(3S):73-76.

    American Heart Association. Get your cholesterol checked. Update of 27 Aug 2007. Available on the Internet at http://www.americanheart.org/presenter.jhtml?identifier=541 through http://www.americanheart.org. Accessed 16 Jul 2004 and 11 Feb 2008.

    Grundy SM, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. 13 Jul 2004. Circulation 110:227-239. Available on the Internet through http://www.circ.ahajournals.org. Accessed 5 Aug 2004 and 11 Feb 2008.

    American Academy of Family Physicians. Heart disease and heart attacks: what women need to know. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/287.html through http://familydoctor.org. Accessed 4 Aug 2004 and 11 Feb 2008.

    American Academy of Family Physicians. Heart disease: assessing your risk. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/292.html through http://familydoctor.org. Accessed 16 Jul 2004 and 11 Feb 2008.

    National Heart, Lung, and Blood Institute of the National Institutes of Health. High blood cholesterol: what you need to know. Available on the Internet at http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm through http://www.nhlbi.nih.gov. Accessed 16 Jul 2004; 2005 rev accessed 11 Feb 2008.

    American College of Preventive Medicine. Screening for lipid disorders. Available on the Internet at http://www.acpm.org/cpslipiddisorders.htm through http://www.acpm.org. Accessed 5 Aug 2004 and 11 Feb 2008.

    American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. Aug 2003. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

    National Heart, Lung, and Blood Institute of the National Institutes of Health. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood pressure in adults (Adult Treatment Panel III) (NIH pub. 01-3670). May 2001. Available on the Internet at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm though http://www.nhlbi.nih.gov. Accessed 15 Jul 2004 and 11 Feb 2008.

    National Heart, Lung, and Blood Institute of the National Institutes of Health. Update on cholesterol guidelines: more-intensive treatment options for higher risk patients (press release). 12 Jul 2004. Available on the Internet at http://www.nhlbi.nih.gov/new/press/04-07-12.htm through http://www.nhlbi.nih.gov. Accessed 4 Aug 2004 and 11 Feb 2008.

  • HIV

    A triagem universal para HIV se tornou rotina nos EUA. Pelo menos de 90% a 95% das pessoas contaminadas produzem anticorpos detectáveis nos exames em três meses após a exposição, e o diagnóstico pode melhorar muito a saúde e a extensão da vida das pessoas infectadas e evita a transmissão para outras. Mulheres grávidas infectadas podem transmitir o vírus para seus bebês.

    O Centers for Disease Control and Prevention (CDC), dos EUA, recomenda:

    • Triagem de todas as pessoas entre 13 e 64 anos de idade, pelo menos uma vez.
    • Triagem de todas as mulheres grávidas.
    • Triagem anual de pessoas com atividades que podem disseminar a infecção.

    Avaliação de risco

    Pessoas nas situações abaixo devem ser testadas logo, mesmo que não apresentem sintomas:

    Contatos sexuais:

    • Sexo não protegido com duas ou mais pessoas
    • Homens que tiveram contato sexuais com homens desde 1975
    • Pessoas que trocam sexo por dinheiro ou por drogas
    • Sexo com pessoas infectadas, bissexuais ou usuários de drogas injetáveis
    • Pessoas em tratamento de doenças transmitidas sexualmente

    Outras preocupações:

    • Usuários de drogas injetáveis (compartilhamento de agulhas não esterilizadas)
    • Receptores de transfusões de sangue entre 1978 e 1985

    A frequência da triagem depende dos contatos sexuais e de outras atividades de risco. Por exemplo, pessoas em relações monógamas podem fazer algum teste apenas uma vez. O risco aumenta quando  indivíduo ou seu parceiro tem contato sexual com mais de uma pessoa ou outro comportamento de risco nos últimos meses.


    Links
    For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-232-4636.
    National Library of Medicine: Online, narrated tutorial on STDs
    Mayo Clinic: STD testing - What to know before your appointment


    Fontes

    Branson BM, et al, for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. 22 Sep 2006. MMWR 55(RR14):1-17. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

    US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

    US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07 through http://www.ahrq.gov. Accessed 28 Jan 2008.

Fontes gerais

Adult preventive care recommendations. May 2005. Massachusetts Health Quality Partners. Available on the Internet at http://www.mhqp.org/guidelines/adultGuidelines.asp?nav=040908 through http://www.mhqp.org. Accessed 4 Feb 2008.

General screenings and immunizations for women. National Women’s Health Information Center, US Department of Health and Human Services. Available on the Internet at http://www.4women.gov/screeningcharts/general through http://www.4women.gov. Accessed 4 Feb 2008.

Guide to Clinical Preventive Services, 2007. US Preventive Services Task Force. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2c.htm through http://www.ahrq.gov. Accessed 4 Feb 2008.

Screening tests and immunizations guidelines for men. National Women’s Health Information Center, US Department of Health and Human Services. Available on the Internet at http://www.4women.gov/screeningcharts/men through http://www.4women.gov. Accessed 4 Feb 2008.

Summary of recommendations for clinical preventive services (rev 6.4). 15 Aug 2007. American Academy of Family Physicians. Available on the Internet at http://www.guideline.gov. Accessed 4 Feb 2008.

Preventive services for healthy living. American Academy of Family Physicians. Available on the Internet at http://familydoctor.org/x1548.xml through http://familydoctor.org. Accessed 19 Oct 2004 and 7 Feb 2008.

Recommended clinical preventive services for adult men. 2006. American Academy of Family Physicians. Available on the Internet at http://www.aafp.org/online/en/home/clinical/exam/agecharts.html through http://www.aafp.org. Accessed 3 Dec 2007.