Complexity of pediatric chronic disease: cross-sectional study with 16,237 patients followed by multiple medical specialties / Complexidade da doença crônica pediátrica: estudo tranversal com 16.237 pacientes seguidos por múltiplas especialidades médicas

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

RESUMO Objetivo: Avaliar dados demográficos e características de crianças e adolescentes com doenças crônicas pediátricas, de acordo com o número de especialidades/paciente. Métodos: Realizou-se um estudo transversal com 16.237 pacientes com doenças crônicas pediátricas durante um ano. A análise foi feita em um sistema eletrônico, de acordo com número de consultas médicas para doenças crônicas pediátricas. Este estudo avaliou dados demográficos, características do seguimento, tipos de especialidades médicas, diagnóstico (10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde - CID-10), número de visitas e complicações agudas. Resultados: Os pacientes acompanhados por três ou mais especialidades simultaneamente tiveram seguimento de maior duração comparados com aqueles seguidos por ≤2 especialidades [2,1 (0,4-16,4) vs. 1,4 (0,1-16,2) anos; p<0,001], bem como maior número de consultas em todas as especialidades. As áreas médicas mais comuns em pacientes acompanhados por ≥3 especialidades foram: psiquiatria (Odds Ratio - OR=8,0; intervalo de confiança de 95% - IC95% 6-10,7; p<0,001); dor/cuidados paliativos (OR=7,4; IC95% 5,7-9,7; p<0,001); doenças infecciosas (OR=7,0; IC95% 6,4-7,8; p<0,001); nutrologia (OR=6,9; IC95% 5,6-8,4; p<0,001). As regressões logísticas mostraram que os pacientes com doenças crônicas pediátricas seguidos por ≥3 especialidades tinham alto risco para: maior número de consultas/paciente (OR=9,2; IC95% 8,0-10,5; p<0,001); atendimentos em hospital-dia (OR=4,8; 95%IC3,8-5,9; p<0,001); atendimentos em pronto-socorro (OR=3,2; IC95% 2,9-3,5; p<0,001); hospitalizações (OR=3,0; IC95%2,7-3,3; p<0,001); internação em terapia intensiva (OR=2,5; IC95% 2,1-3,0; p<0,001); óbitos (OR=2,8; IC95%1,9-4,0; p<0,001). Os diagnósticos de asma, obesidade, dor crônica, transplante e infecção do trato urinário foram mais frequentes nos pacientes seguidos por três ou mais especialidades. Conclusões: O presente estudo mostrou que pacientes com doenças crônicas pediátricas que necessitaram de múltiplas especialidades médicas simultaneamente apresentavam doenças complexas e graves, com diagnósticos específicos.

¿ Es necesario tener conocimientos avanzados de estadística para acceder a las publicaciones módicas? / Is it necessary to have advanced statistical knowledge to access medical literacy?

La introducció;n de análisis estadísticos en revistas biomó;©dicas debe atribuirse a Dunn y a Greewood en la dó;©cada del 30, quienes reflejan los conceptos del análisis e interpretació;n estadística. El objetivo del trabajo fue analizar la utilizació;n de distintas pruebas estadísticas y el grado de accesibilidad análisis-dependiente y artículo-dependiente de los artículos originales publicados en la revista Medicina (B Aires) en el período 2008-2017. Se realizó; un estudio bibliomó;©trico, descriptivo, observacional, de corte transversal, en el cual se incluyeron los artículos originales que fueron evaluados de acuerdo a la escala propuesta por Mora Ripoll y col. Se revisaron 301 artículos en idioma espaó;±ol, el 96% presentó; análisis estadísticos. Entre los 215 artículos que emplearon alguna tó;©cnica de estadística inferencial, el 49.7% utilizó; la prueba chi-cuadrado, pruebas z para proporciones, el test exacto de Fisher o prueba de McNemar. El 29.2% empleó; pruebas t de student y pruebas z, incluyendo el uso de estas tó;©cnicas o de intervalos de confianza para contrastes de conformidad de medianas, y/o homogeneidad de medianas (dos muestras), en muestras apareadas o independientes. Los resultados indican que un lector conocedor de las pruebas incluidas en el Nivel II tendrá acceso estadístico al 75% de los artículos originales publicados. Se comprobó; que no es necesario tener conocimientos avanzados de estadística para acceder a la mayoría de las publicaciones, pero sí es importante que estos contenidos sean desarrollados haciendo hincapí en el razonamiento estadístico por sobre la aplicació;n y utilizació;n de software o la elecció;n del test adecuado.

The introduction of statistical analysis in biomedical journals should be attributed to Dunn and Greenwood in the 1930s, who reflect the concepts of statistical analysis and interpretation. The aim of this study was to analyze the use of different statistical tests and the level of accessibility analysis-dependent and article-dependent of the original articles published in the journal Medicina (B Aires) in the period 2008-2017. A bibliometric, descriptive, observational, cross-sectional study was carried out, in which the original articles were evaluated according to the scale proposed by Mora Ripoll et al. From the 301 articles in Spanish reviewed, 96% presented statistical analyses. Among the 215 articles that used some inferential statistics technique, 49.7% used the chi-square test, z tests for proportions, the Fisher exact test or the McNemar test; 29.2% used student t-tests and z-tests, including the use of these techniques or the use of confidence intervals for medium-conformance contrasts, and /or median-homogeneity (two samples), in paired or independent samples. The results indicate that a reader who knows about the tests included in Level II will have statistical access to 75% of the original articles published. It was found that it is not necessary to have advanced knowledge of statistics to access most publications, but it is important that these contents are developed with emphasis on statistical reasoning over the application and use of software or the choice of the appropriate test.

Who and Where are the University of São Paulo Medical School Graduates?

OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students' career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

Incidence, psychosocial burden, and economic impact of genital warts in Mexico / Incidencia, carga psicosocial e impacto económico de las verrugas genitales en México

Abstract: Objective: To estimate the burden of genital warts (GW) in Mexico. Materials and methods: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. Results: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. Conclusions: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

Resumen: Objetivo: Estimar la carga por verrugas genitales (VG) en México. Material y métodos: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. Resultados: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. Conclusiones: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

Análise comparativa da base social da Medicina e Enfermagem no Brasil entre os anos de 2000 e 2010 / Comparative analysis of the social base of the medical and nursing professions in Brazil from 2000 to 2010 / Análisis comparativo sobre la base social en Medicina y enfermería en Brasil entre los años 2000 y 2010

O objetivo deste artigo é analisar as alterações ocorridas durante os anos 2000 na base social das profissões da Medicina e Enfermagem no Brasil, como resultado da expansão do Ensino Superior iniciada na segunda metade dos anos 1990. De um lado, analisa descritivamente a base social de recrutamento valendo-se dos dados do questionário socioeconômico do Exame Nacional de Desempenho dos Estudantes de 2004 e 2010, referentes aos ingressantes e concluintes dos cursos de Medicina e Enfermagem. De outro, analisa a base social dos habilitados nas profissões valendo-se dos dados do Censo Demográfico do Instituto Brasileiro de Geografia e Estatística de 2000 e 2010. Os resultados mostram que ocorreu ampliação da base social de recrutamento das duas profissões, sobretudo pelo crescimento do alunado proveniente de famílias de baixa renda e que se declararam negros/as, pardos/as e mulato/as. Já a base social dos habilitados passou por uma reconfiguração, caracterizada pelo rejuvenescimento da população e pela diminuição das recompensas no mercado de trabalho. Ambos os processos foram vivenciados de forma distinta entre e dentro das profissões, destacando a existência de diferenças na capacidade de cada grupo profissional em mobilizar recursos que são próprios do mundo profissional e que lhes podem garantir posições especiais no mercado de trabalho e na estrutura social.

The aim of this study was to analyze the changes in the 2000s in the social base of the medical and nursing professions in Brazil, as a result of the expansion of higher education in the country beginning in the late 1990s. The article begins with a descriptive analysis of the social base of recruitment, drawing on data from the socioeconomic questionnaire of the National Student Performance Exam in 2004 and 2010, for incoming and graduating students in medicine and nursing. Next, it analyzes the social base of certified physicians and nurses, using data from the 2000 and 2010 Population Censuses. The results show that there was an expansion in the social base of recruitment in both professions, especially an increase in students from low-income families and those self-identified as black or brown. The social base of certified physicians and nurses underwent a reconfiguration, characterized by rejuvenation and a decrease in work market remuneration. The two processes were experienced differently within and between the professions, highlighting the existence of differences in the respective professional groups' capacity to mobilize resources proper to the professional world and that can guarantee special positions in the work market and in social structure.

El objetivo de este artículo es analizar las alteraciones ocurridas durante la primera década del año 2000, en lo que se refiere a la base social en las profesiones de medicina y enfermería en Brasil, como resultado de la expansión de la enseñanza superior, iniciada en la segunda mitad de la década de 1990. Por un lado, se analiza descriptivamente la base social en la selección de personal, valiéndose de los datos de la encuesta socioeconómica del Examen Nacional de Desempeño de los Estudiantes, desde 2004 hasta 2010, en cuanto a quienes accedían y concluían los cursos de medicina y enfermería. Por otro, se analiza la base social de los habilitados en esas profesiones, usando los datos del Censo Demográfico de 2000 y 2010. Los resultados muestran que se produjo una ampliación de la base social en el acceso a estas dos profesiones, sobre todo por el crecimiento del alumnado proveniente de familias de baja renta, y que se declararon negros/as, mestizo/as y mulato/as. Ya la base social de quienes fueron habilitados sufrió una reconfiguración, caracterizada por el rejuvenecimiento de la población, y por la disminución de los subsidios en el mercado de trabajo. Ambos procesos fueron vividos de forma distinta entre y dentro de las propias profesiones, destacando la existencia de diferencias en la capacidad de cada grupo profesional al movilizar recursos, que son propios del mundo profesional, y que les pueden garantizar posiciones especiales en el mercado de trabajo y en la estructura social.

Procesos de Acreditación de la Formación de Posgrado de Carreras de Salud en Argentina. Hacia la Consolidación de un Sistema Articulado / Accreditation Processes of Postgraduate Training Health Careers in Argentina. Towards the Consolidation of an Articulated System

Introducción: El título de grado de médico es habilitante para el ejercicio de la profesión en cualquier especialidad. No obstante, la mayoría de los médicos egresados eligen continuar su formación de posgrado. La misma incluye las carreras de especialidades, maestrías y doctorados, dependientes de Educación, y las Residencias, dependientes de Salud. Existen carreras de especialista universitario que están asociadas a residencias. Algunas debieron pasar por un doble proceso de evaluación, tanto por parte de la CONEAU, como por parte del SNARES. Estas situaciones evidencian la necesidad de consolidar un sistema integrado de acreditación para la formación de médicos especialistas, que se oriente a alcanzar similares estándares de calidad en la formación. Objetivo: Establecer los procesos necesarios para la construcción de un sistema de acreditación conjunta de las Carreras de posgrado de Especialista Universitario en el campo de la salud que funcionan en asociación con una Residencia del Sistema Nacional de Residencias de Equipo de Salud. Metodología: La presente investigación se planteó como un estudio de implementación, de diseño cualitativo, en el que utilizaron una variedad de técnicas de recolección de datos. Se analizó la normativa y los procesos de acreditación llevados adelante por el SNARES, sobre las residencias, como por la CONEAU, sobre las carreras de especialista universitario, en todo el ámbito nacional. El análisis empírico de casos en donde tuvo lugar un doble proceso de acreditación por estar asociada una carrera a una Residencia, se realizó sobre una muestra definida en relación con los hallazgos de la primera etapa del estudio. Resultados y conclusiones: Pensar en un sistema de acreditación integrado requiere revisar los procesos de definición de una política de formación de especialistas médicos que garantice criterios de equidad y de calidad en todo el territorio. La cantidad de carreras de especialización universitaria asociadas a Residencias es aun marginal en relación con la cantidad de sedes de Residencia a nivel nacional. Se visualiza como el requisito fundamental la necesidad de consolidar políticas a nivel del Estado. En la evaluación de las formaciones se evidenció la posibilidad de unificar los procedimientos para las evaluaciones. Y la necesidad de consensuar estándares diferenciados por especialidad.(AU)

Background: A degree of medical doctor authorizes professional practice. However, most physicians choose to continue their post graduate training through residencies or university specialist careers. There are specialist careers associated to residencies which undergo a double evaluation process before certification entities of both systems (CONEAU and SNARES). The need to investigate if it is possible to count with a certification integrated system for them is shown. Purpose: To establish the processes for developing a joint certification system of both university specialist careers and medical residencies. Methods: qualitative design, implementation research. A variety of data collection techniques and interviews to key informants were used. Regulation was analyzed, the universe of specialist careers and medical residencies as well as certification processes performed on associated training were surveyed. Results: Characteristics of both certification systems are linked to the origin of each training system. The development degree of the regulation is consistent with the age of each certification system. The number of university specialization careers associated to residencies is marginal as regards the number of residencies at a national level. There is wide consensus among actors about the need and possibility to articulate both systems. Certification analysis showed the technical feasibility to join evaluation procedures progressively and the need to develop common standards for each specialty. Conclusions: The analysis regarding an integrated certification system leads to review the creation processes of medical specialist training policies, with equity, quality and territorial criteria as well as the importance of building consensus among training actors.(AU)

Alternativas de formación elegidas por los concursantes del Sistema Nacional de Residencias Médicas que habiendo aprobado el examen único no accedieron al cargo. Estudio multicéntrico en las jurisdicciones de Santa Fe, Neuquen, Salta y San Juan. Año 2014 / Alternatives of training chosen by the contestants of the national system of medical residences that having passed the single examination did not accede to the charge. Multicenter study in the jurisdictions of Santa Fe, Neuquen, Salta and San Juan. Year 2014

Introducción: En los últimos años se observa una tendencia creciente a la no cobertura de los cargos vacantes de residencias médicas en ciertas especialidades y regiones del país, desconociéndose qué alternativas de formación adoptan quienes deciden no acceder al cargo, ni las razones por las que no lo aceptan. Objetivo: Reconocer las alternativas de formación que eligen aquellos médicos concursantes del Examen Único (EU) que, habiendo aprobado el examen, no adjudican un cargo de residencia, y las razones de dichas elecciones. Metodología: Se diseñó un estudio de carácter cuanti-cualitativo, que se desarrolló en dos etapas. Un estudio descriptivo de corte transversal, donde se aplicó un cuestionario cerrado a una muestra intencional integrada por médicos que se postularon en las jurisdicciones bajo estudio y que, habiendo aprobado el EU, no acceden al cargo. Seguidamente se realizó un estudio cualitativo, mediante la aplicación de entrevistas semiestructuradas, donde se abordaron aspectos que pudieran haber influido en la decisión adoptada por los profesionales. Resultados y conclusiones: Los resultados del estudio arrojan que la Residencia, y en particular la del sector público, es la opción privilegiada por los egresados recientes. Por otra parte, hay oferta suficiente de residencias para que todos los médicos realicen su formación de posgrado. Por lo tanto, el desafío es cómo hacer confluir estos dos hechos en pos de las necesidades sanitarias, teniendo en cuenta las tendencias que ha arrojado este estudio: los jóvenes privilegian el prestigio de las sedes de formación y la cercanía con sus vínculos afectivos.(AU)

Excesso de médicos na região sul do Brasil / Excess of physicians in southern Brazil

Introdução: Por muitos anos houve falta de médicos em muitas cidades do Brasil. Porém, a política nacional para a abertura de faculdades de medicina vem se caracterizando por um crescente e excessivo número de vagas ofertadas nos últimos anos. O objetivo deste estudo foi avaliar os dados sobre a criação de novas faculdades de medicina nos três estados da região sul do Brasil, analisando os em relação ao número de matrículas disponibilizadas e o número de médicos formados nos três estados que compõem a região. Métodos: Os diretores das faculdades de medicina nos três estados da região sul foram contatados para a obtenção dos dados sobre a criação de suas instituições. Realizou-se também a análise de dados referentes ao número de médicos formados e registrados nos conselhos regionais de medicina dos três estados no período de 1960 a 1999. Resultados: Houve um expressivo aumento no número de instituições criadas e vagas oferecidas ao longo dos anos em todos os estados analisados. No período de 1960 a 1999, o estado do Rio Grande do Sul já era autossuficiente em matrículas médicas, porém os estados de Santa Catarina e Paraná ainda apresentavam um número insuficiente de matrículas em cursos médicos. Conclusão: Apesar do número de médicos ter sido insuficiente durante alguns anos, os três estados analisados já apresentam um excessivo número de médicos formados. É necessário, portanto, analisar a relação entre o atual número comprovadamente excessivo de médicos e o quanto isto possa prejudicar a qualidade do atendimento ao paciente.

Introduction: For many years there was a shortage of physicians in many Brazilian cities. However, the national policy for the creation of medical colleges has been characterized by an excessive and increasing number of offered vacancies in recent years. The aim of this study was to evaluate the data for the creation of new medical schools in three southern states of Brazil, analyzing them in relation to the number of available registrations and the number of graduated doctors in the three states comprising the region. Methods: The directors of medical schools in three southern states were contacted to obtain data on the establishment of their institutions. We also analyzed the data on the number of graduated physicians registered in the regional medical councils of the three states from 1960 to 1999. Results: There was a significant increase in the number of created institutions and offered vacancies over the years in all three states analyzed. In the 1960-1999 period, the state of Rio Grande do Sul was self-sufficient in medical enrollments, but the states of Santa Catarina and Paraná still had an insufficient number of enrollments in medical courses. Conclusion: Although the number of physicians was insufficient for several years, today the three states already have an excessive number of medical graduates. It is therefore necessary to examine the relationship between the excessive number of physicians and how this might affect the quality of patient care.

Formación de médicos especialistas en el Sistema de Servicios de Salud de Chile: Su evolución en el período 2007-2010 / Training of specialists in the Chilean national health services

Several institutions, such as the Ministry of Health, Universities, the Chilean Medical Association, Scientific societies and public opinion, recognize that there is a deficiency of specialized physicians in Chile. To overcome this shortage of specialists, the Ministry of Health, along with universities, is developing diverse initiatives to train specialists and cope with the requirements of the country. Seventy five percent of posts offered were filled by physicians. The number of positions increased from 173 in 2007 to 576 in 2010, with a cumulative total of 1582 physicians in four years. Fifty two percent are being trained in Basic Primary Specialties and 48 percent in primary specialties. Thirty three percent of graduates have the obligation to continue working in the public service during a certain lapse. This figure will increase to 50 percent in the following years. These specialists are mainly working in the more densely populated regions of the country. The universities that offer the higher number of training positions are the University of Chile, The Catholic University of Chile and the University of Santiago.

Disponibilidad de médicos y especialistas en Chile / Availability of physicians and specialists in Chile

The availability and planning of Human Resources are important issues in many countries, as it is a key factor to cope with the critical challenges of Health Care Systems. In Chile, the Ministry of Health has undertaken several studies in order to improve knowledge about the medical workforce both in public and private sectors. The aim of this paper is to update and systematize the existing data on physicians and specialists availability in Chile. Several information sources were crossed to obtain new and more precise figures about this topic. According to the Internal Revenue System, 29.996 physicians practice medicine in the country, 43 percent of them hired in public services, part or full time. There is a high concentration of professionals in the central regions of Chile. Being the overall density of physicians of one per 559 inhabitants, the figures in the central region is one per 471 and one per more than 800 in the South and North. Between 2004 and 2008, the public sector increased its physician workforce by more than 80 percent in primary health care and more than 20 percent in the secondary and tertiary levels. This paper presents a method for a more rigorous identification of the categories of general practitioner and specialist respectively, and the results obtained from the databases used.

Síndrome de Turner: um diagnóstico pediátrico frequentemente realizado por não pediatras / Turner syndrome: a pediatric diagnosis frequently made by non-pediatricians

OBJETIVO: Analisar as características clínicas de pacientes com suspeita de síndrome de Turner (ST) em um serviço de referência. MÉTODOS: Análise retrospectiva de 425 pacientes. Foram colhidos dados de idade, estatura e estádio puberal no momento do diagnóstico, bem como da especialidade do médico que encaminhou a paciente. Comparação das pacientes com e sem ST e daquelas com ST de acordo com a especialidade e análise de correlação entre estatura e idade ao diagnóstico. RESULTADOS: O diagnóstico de ST foi feito, em 36,9 por cento dos casos, com média de idade de 12,0 anos e escore z da estatura = -3,09; havia atraso puberal em 71,4 por cento das 63 pacientes maiores de 13 anos. Comparadas às demais, as meninas com ST apresentavam maior deficit na estatura e maior frequência de atraso puberal. Pacientes com ST encaminhadas por pediatras eram significativamente mais jovens (9,3 anos versus 15,4 anos), porém com estatura e frequência de atraso puberal semelhantes às daquelas encaminhadas por não pediatras. Houve correlação linear negativa significativa entre idade ao diagnóstico e estatura no total de pacientes com ST, mas não entre as encaminhadas por não pediatras. CONCLUSÕES: A média de idade ao diagnóstico da ST ainda é superior àquela dos países desenvolvidos, e a presença de sinais puberais espontâneos e/ou de deficit de crescimento menos acentuado em algumas pacientes pode contribuir para o atraso na suspeita clínica. É necessária divulgação entre pediatras e não pediatras dos conhecimentos necessários ao diagnóstico precoce da ST.

OBJECTIVE: To analyze the clinical features of patients with suspected diagnosis of Turner syndrome (TS) in a reference service. METHODS: Retrospective analysis of 425 patients: data pertaining to age, height and pubertal stage at diagnosis, as well as the specialty of the physician who referred the patient were collected. Patients with and without TS were compared, as well as those with TS according to specialty of the physician; the correlation between age and height at diagnosis was analyzed. RESULTS: TS diagnosis was made in 36.9 percent of the cases with a mean age of 12.0 years, and height z score = -3.09; pubertal delay was found in 71.4 percent of the 63 patients aged more than 13 years. When compared to the other patients, girls with TS had a higher height deficit and higher frequency of pubertal delay. TS patients referred by pediatricians were significantly younger (9.3 years vs. 15.4 years), but their height and frequency of pubertal delay were similar to those referred by non-pediatricians. There was a significant negative linear correlation between age and height in the total amount of patients with TS, but not among those referred by non-pediatricians. CONCLUSIONS: Mean age at TS diagnosis is still higher than that observed in developed countries, and the presence of spontaneous pubertal signs and/or less pronounced growth deficit in some cases may contribute to delayed clinical suspicion of TS. Information required for early TS diagnosis must be spread among pediatricians and non-pediatricians.