{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:06:23Z","timestamp":1791446783941,"version":"4.3.3"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,2,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              ), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              in schoolchildren (aged 5\u201318\u00a0years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The\n              <jats:styled-content style=\"fixed-case\">PROVAR<\/jats:styled-content>\n              (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              were analyzed. In 26\u00a0months, 12\u00a0048 students were screened in 52 public schools (n=10\u00a0901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9\u00a0years, and 55.4% were girls. Overall\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (\n              <jats:italic>P<\/jats:italic>\n              =0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Prevalence was higher in children \u226512\u00a0years (5.3% versus 3.1%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and girls (4.9% versus 4.0%;\n              <jats:italic>P<\/jats:italic>\n              =0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09\u20131.17;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) was independently associated with\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high\u2010income areas. These data are important for the formulation of public policies to confront\n              <jats:styled-content style=\"fixed-case\">RHD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.008039","type":"journal-article","created":{"date-parts":[[2018,2,15]],"date-time":"2018-02-15T01:10:37Z","timestamp":1518657037000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Bruno R.","family":"Nascimento","sequence":"first","affiliation":[{"name":"Division of Cardiology and Cardiovascular Surgery and Telehealth Center \u2010 Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"},{"name":"School of Medicine \u2010 Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Children's National Health System, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmo P.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Surgery and Telehealth Center \u2010 Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"},{"name":"School of Medicine \u2010 Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana C.","family":"Diamantino","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Surgery and Telehealth Center \u2010 Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaciane K. 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