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Ernesto Succi Desenvolvimento De Um Programa De Apoio À Decisão

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Ernesto Succi Desenvolvimento De Um Programa De Apoio À Decisão Ernesto Succi Desenvolvimento de um programa de apoio à decisão para análise do crescimento, nutrição e maturação sexual para uso na atenção primária Tese apresentada à Universidade Federal de São Paulo para obtenção do título de Doutor em Ciências São Paulo 2010 Ernesto Succi Desenvolvimento de um programa de apoio à decisão para análise do crescimento, nutrição e maturação sexual para uso na atenção primária Tese apresentada à Universidade Federal de São Paulo para obtenção do título de Doutor em Ciências Orientador: Prof. Dr. Daniel Sigulem São Paulo 2010 Ficha Catalográfica Succi, Ernesto Desenvolvimento de um programa de apoio à decisão para aná- lise do crescimento, nutrição e maturação sexual para uso na atenção primária / Ernesto Succi – São Paulo, 2010 xviii, 397f Tese (Doutorado) - Universidade Federal de São Paulo - UNI- FESP. Programa de pós-graduação em Saúde Coletiva Título em inglês: Decision support system development for growth, nutrition, and sexual maturation analysis for primary care use. 1. Diagnóstico por computador 2. Crescimento e desenvolvi- mento 3. Tomada de decisões assistida por computador 4. Maturi- dade sexual 5. Bases de conhecimento Universidade Federal de São Paulo - UNIFESP Medicina Preventiva Chefe do Departamento: Prof. Dr. Luiz Roberto Ramos Coordenador do Curso de Pós-Graduação: Prof. Dr. Luiz Roberto Ramos Ernesto Succi Desenvolvimento de um programa de apoio à decisão para análise do crescimento, nutrição e maturação sexual para uso na atenção primária Presidente da banca: Prof. Dr. Daniel Sigulem BANCA EXAMINADORA Profa. Dra. Claudia Galindo Novoa Barsottini Prof. Dr. Domingos Palma Profa. Dra. Maria Alice Neves Bordallo Profa. Dra. Maria Ignez Saito Aprovado em / / Siglas e Abreviaturas ACC: sigla para avanço ou adiantamento constitucional do crescimento. AEGF: sigla para alta estatura genético-familiar. AMB: sigla para Associação Médica Brasileira. ABNT: sigla para Associação Brasileira de Normas Técnicas. BEGF: sigla para baixa estatura genético-familiar. BSD: sigla para Berkeley Software Distribution. BIV: sigla para biologically implausible values. CAPES: sigla para Coordenação de Aperfeiçãomento do Pessoal de Ensino Superior. CD: sigla para compact disk. CDC: sigla para Centers for Disease Control and Prevention. CFM: sigla para Conselho Federal de Medicina. CLI: sigla para command-line interface. cm: abreviatura para centímetro ou centímetros. CNRM: sigla para Comissão ou Conselho Nacional de Residência Médica. CUA: sigla para Common User Access. dmg: sigla para Disk iMaGe. DP: sigla para desvio-padrão. ESF: sigla para Estratégia Saúde da Família. EUA: sigla para Estados Unidos da América. exe: abreviatura para executável. GH: sigla para growth hormone. GNU: sigla para GNUs not Unix. GNU GPL: sigla para General Public License. iv v GNU LGPL: sigla para Lesser General Public License. GUI: sigla para graphical user interface. h2: sigla para hereditariedade. HAPO: sigla para height adjusted for pubertal onset. html: sigla para HyperText Markup Language. IBGE: sigla para Instituto Brasileiro de Geografia e Estatística. ICP: sigla para infancy, childhood, puberty. ICPN: sigla para ICP new. IDE: sigla para integrated development environment. IHC: sigla para interface humano-computador. IMC: sigla para índice de massa corpórea ou corporal. ini: abreviatura para inicialização. IO: sigla para idade óssea. IOTF: sigla para International Obesity Task Force. IP: sigla para internet protocol. JVM: sigla para Java virtual machine. kg: abreviatura para quilograma ou quilogramas. LGPL: sigla para Lesser General Public License. LWPES: sigla para Lawson Wilkins Pediatric Endocrine Society. MFC: sigla para Medicina de Família e Comunidade. MGC: sigla para Medicina Geral e Comunitária. MS: sigla para Ministério da Saúde. NCHS: sigla para National Center for Health Statistics. NHANES: sigla para National Health and Nutrition Examination Survey. OMS: sigla para Organização Mundial da Saúde. ONU: sigla para Organização das Nações Unidas. PAD: sigla para programa de apoio à decisão. PADMAS1: sigla para Programa de Apoio à Decisão para Análise da Maturação Sexual para Uso em Atenção Primária. pdf: sigla para portable document file. vi PEF: sigla para predição de estatura final. PNSN: sigla para Pesquisa Nacional de Saúde e Nutrição. POF: sigla para Pesquisa de Orçamentos Familiares. PPC: sigla para puberdade precoce completa, central ou verdadeira. PPP: sigla para puberdade precoce incompleta, periférica ou pseudopuberdade precoce. PROSAD: sigla para Programa Saúde do Adolescente. PSF: sigla para Programa Saúde da Família. RCC: sigla para atraso ou retardo constitucional do crescimento. RMMFC: sigla para Residência Médica de Medicina de Família e Comunidade. RWT: sigla para Roche-Wainer-Thyssen. SAD: sigla para sistema de apoio à decisão. SBMFC: sigla para Sociedade Brasileira de Medicina de Família e Comunidade. SUS: sigla para Sistema Único de Saúde. SVG: sigla para scalable vector graphics. T4: sigla para tiroxina. TSH: sigla para thyroid stimulating hormone. TW: sigla para Tanner-Whitehouse. UNIFESP: sigla para Universidade Federal de São Paulo. URL: sigla para uniform resource locator. USPTO: sigla para United States Patent and Trademark Office. UTF: sigla para unicode transformation format. UTF8: sigla para unicode transformation format de 8-bit. xhtml: sigla para eXtensible HyperText Markup Language. Sumário 1 Introdução 1 2 Objetivos 5 2.1 Objetivo geral ..................................... 5 2.2 Objetivos específicos ................................. 5 3 Revisão da Literatura 6 3.1 Sobre a estatura .................................... 8 3.2 Sobre o peso ...................................... 10 3.3 Sobre a maturação sexual............................... 12 3.4 Sobre a construção das curvas. 14 3.5 Sobre programas de apoio à decisão . 14 4 Material e Métodos 17 4.1 Construção da ontologia............................... 17 4.2 Construção do programa de apoio à decisão para análise da maturação sexual 18 4.3 Construção da interface humano-computador (IHC) . 18 4.4 Do glossário ...................................... 19 4.5 Validade do programa de apoio à decisão . 19 4.6 Validação da interface humano-computador . 19 5 Resultados 21 vii viii 5.1 Da ontologia...................................... 21 5.2 Da construção..................................... 24 5.3 Avaliação ........................................ 33 5.4 Do glossário ...................................... 45 6 Discussão 46 6.1 Da construção da ontologia ............................. 47 6.2 Sobre a construção do PADMAS1 ......................... 56 6.3 Sobre a avaliação do PADMAS1 .......................... 56 6.4 Sobre a construção da IHC . 58 6.5 Sobre a avaliação da IHC .............................. 59 6.6 Sobre o glossário.................................... 65 7 Conclusão 68 Referências Bibliográficas 68 A Busca por programa: estratégia e resultados 117 B Ontologia: coleção de regras 127 C Casos-teste 171 D Respostas avaliadores 173 E Avaliação IHC: instrumento 181 F Avaliadores de IHC: demografia, protocolo e resultados 185 F.1 Protocolo para aplicação do instrumento de avaliação do IHC . 188 F.2 Mapa dos resultados dos avaliadores do IHC, sem tratamento estatístico . 188 G Glossário: cópia não-funcional 193 Lista de Figuras 5.1 Exemplo de regra:hipogonadismo.. 25 5.2 IHCdo usuário inicial ................................ 27 5.3 IHCdo usuário avançado .............................. 27 5.4 Exemplo de página e imagem para escolha do estádio de mamas, sem tooltips. 29 5.5 Exemplo de página e imagem para escolha do estádio de mamas, com tooltips. 30 5.6 Imagem do glossário ................................. 45 E.1 Formulário de avaliação ............................... 181 ix Lista de Tabelas 3.1 Comparação entre os gráficos NCHS1977 e CDC/NCHS2000 . 8 3.2 Sistemas de classificação da nutrição em crianças e jovens baseados no IMC 12 5.1 Estudo da concordância entre especialistas e o PADMAS1 referente à ES- TATURA........................................ 34 5.2 Estudo da concordância entre especialistas e o PADMAS1 referente à PEF 34 5.3 Estudo da concordância entre especialistas e o PADMAS1 referente ao IMC 35 5.4 Estudo da concordância entre especialistas e o PADMAS1 referente à MA- TURAÇÃOSEXUAL ................................ 35 5.5 Estudo da concordância entre especialistas e o PADMAS1 referente à IO . 36 5.6 Estudo da concordância entre especialistas e o PADMAS1 referente às RE- COMENDAÇÕES.................................. 36 5.7 Estudo da concordância interclasses e com o PADMAS1 referente à ESTA- TURA.......................................... 37 5.8 Estudo da concordância interclasses e com o PADMAS1 referente ao PEF 37 5.9 Estudo da concordância interclasses e com o PADMAS1 referente ao IMC 37 5.10 Estudo da concordância interclasses e com o PADMAS1 referente à MA- TURAÇÃOSEXUAL ................................ 37 5.11 Estudo da concordância interclasses e com o PADMAS1 referente à IO . 38 5.12 Estudo da concordância interclasses e com o PADMAS1 referente às RE- COMENDAÇÕES.................................. 38 5.13 Distribuições de frequências simples quanto ao sexo . 39 5.14 Distribuições de frequências simples quanto ao grupo de idades . 39 5.15 Distribuições de frequências simples quanto à categoria . 39 x xi 5.16 Distribuições de frequências simples quanto às especialidades . 39 5.17 Distribuições de frequências simples em relação a pergunta 1 . 40 5.18 Distribuições de frequências simples em relação à pergunta 2 . 40 5.19
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