ABSTRACT
Resumen Objetivo: El Trastorno por Déficit de Atención con Hiperactividad/impulsividad (TDAH) es una de las dificultades de aprendizaje más comunes en las escuelas chilenas. Se caracteriza por un patrón de funcionamiento atípico en atención e inhibición, con fuerte compromiso de otras funciones ejecutivas. Uno de los desafíos que plantea este trastorno está referido al proceso de diagnosis, el cual no suele ser suficientemente preciso. Se pretende explorar las diferencias en la distribución de dos muestras de estudiantes con y sin TDAH diagnosticadas con una escala de observación conductual a través de la evaluación de las funciones ejecutivas de atención, inhibición y flexibilidad cognitiva. Método: En este estudio se evaluó a 132 escolares, 66 con TDAH y 66 sin TDAH, en las variables de atención, inhibición y flexibilidad cognitiva de un colegio de la ciudad de Concepción en Chile. Se contrastó el rendimiento cognitivo con los diagnósticos y se reagrupó a los estudiantes en los subtipos conocidos del trastorno. Resultados: La evaluación neuropsicológica mostró que en el grupo con TDAH había alumnos que no cumplían los criterios diagnósticos para estar incluidos en él. En el grupo sin TDAH se observó un fenómeno semejante. En ambos grupos la evaluación neuropsicológica de la atención y la inhibición resultaron útiles para diagnosticar con mayor certeza y para determinar el subtipo al que pertenecía cada estudiante con TDAH detectado. La flexibilidad cognitiva solo permitió diferenciar a los sujetos con y sin TDAH. Conclusiones: En ambos grupos estudiados fue posible encontrar sujetos mal diagnosticados; el sobrediagnóstico fue de 43,93 % en el grupo con TDAH, mientras que el infradiagnóstico fue de 42,42 % en el grupo sin TDAH.
Abstract Objective: Attention Deficit Hyperactivity/Impulsivity Disorder (ADHD) is one of the most common learning difficulties in Chilean schools. It is characterized by an atypical functioning pattern in attention and inhibition, strongly compromising other executive functions. One of the challenges posed by this disorder is the diagnosis process, which is often not sufficiently accurate. The intention is to study the distribution of two students samples, with and without ADHD, diagnosed by a behavioral observation scale through the evaluation of attention, inhibition, and cognitive flexibility executive functions. Method: This study evaluated 132 students, 66 with ADHD and 66 without ADHD, considering the attention, inhibition, and cognitive flexibility variables of a school in the city of Concepción in Chile. Cognitive performance was contrasted with the diagnoses, and students were regrouped in the disorder known subtypes. Results: The neuropsychological evaluation showed that in the ADHD group, there were students who did not meet the diagnostic criteria to be included in the group. A similar phenomenon was observed in the group without ADHD. In both the groups, the neuropsychological evaluation of attention and inhibition was useful in providing a more certain dignosis and in determining the subtype to which each student detected with ADHD belonged. Cognitive flexibility was only useful in differentiating betwen the subjects with and without ADHD. Conclusions: In both the groups studied, it was possible to find misdiagnosed subjects; the overdiagnosis was 43,93 % in the ADHD group, while the under-diagnosis was 42,42 % in the group without ADHD.
ABSTRACT
El síndrome del X frágil (SXF) es una anomalía genética causada por la replicación excesiva en la secuencia del nucleótido CGG que ocasiona anomalías físicas y psicológicas importantes, las cuales repercuten en el desarrollo intelectual del niño, además de que es la segunda causa genética más importante de retraso mental después del síndrome de Down; en ocasiones, y debido a la transición epidemiológica los trastornos de déficit de atención así como la hiperactividad, son confusos en el diagnóstico clínico y puede ser que el SXF sea subdiagnosticado. En la práctica estomatológica los trastornos del comportamiento son de suma importancia, ya que la piedra angular en el manejo de la conducta es la comunicación. Este trabajo está destinado a estimular al clínico para que busque más en los pacientes con retraso mental, trastorno por déficit de atención (TDA) e hiperactividad para encontrar el SXF, ya que el subdiagnóstico complica el tratamiento, el cual es específico y el consejo genético es importante en estos pacientes.
Fragile X syndrome (FXS) is a genetic anomaly caused by excessive replication in the CGG nucleotide sequence which elicits severe physiological and physical anomalies which impair the child's intellectual development. Moreover, FXS constitutes, after Down's syndrome, the second most frequent genetic cause for mental retardation. Due to epidemiological transition, attention deficit disorders as well as hyperactivity are confused in the clinical diagnosis; this might lead to a situation where FXS might be under-diagnosed. In the realm of stomatological practice, behavior disorders are most important since communication can be considered the cornerstone of behavior management. The present study purports the aim of encouraging the clinician to look further into patients afflicted with mental retardation, TDA and hyperactivity to find FXS since under-diagnosis impairs treatment, is specific and genetic counseling for these patients is of the utmost importance.
ABSTRACT
El asma bronquial es la enfermedad crónica más frecuente de la infancia, cuya prevalencia estimada en Cuba es de 8,2 por ciento. La identificación y el control de los factores de riesgo constituyen un pilar importante en el manejo de esta entidad. Objetivos: caracterizar el comportamiento clínico-epidemiológico del asma bronquial en menores de 15 años del policlínico Ana Betancourt. Métodos: se realizó un estudio descriptivo de corte transversal, durante el período del mes de abril de 2010 a marzo de 2011. Inicialmente se aplicó el cuestionario ISSAC para identificar un posible subregistro de asma. Se empleó la clasificación Global Initiative for Asthma 2007, que permitió agrupar clínicamente a los menores en cuatro categorías. Finalmente se aplicó, a la totalidad de la muestra, un cuestionario para la identificación de los factores de riesgo. Resultados: se identificó una morbilidad oculta de 9,3 por ciento. Con asma leve intermitente: 30 pacientes; leve persistente: 21; moderado persistente: 28 y con asma severa: 14. La totalidad de los pacientes tenían antecedentes familiares de atopia y desencadenaban las crisis con los cambios climáticos. El 95,0 por ciento era sensible a inhalantes respiratorios y en el 64,0 por ciento de los hogares se detectó la presencia de fumadores. Conclusiones: el asma bronquial persiste como una enfermedad infradiagnosticada. En el orden epidemiológico, los antecedentes familiares de atopia y los cambios de tiempo, aventajaron a los restantes factores de riesgo asociados...
Bronchial Asthma is the most common chronic disease of childhood in Cuba whose estimated prevalence is 8.2 percent. The identification and control of its risk factors is an important pillar in the management of this entity. Objective: to characterize the clinical and epidemiological behavior of Asthma in children younger 15 years at Ana Betancourt polyclinic. Methods: a descriptive cross-sectional study was conducted from April 2010 to March 2011. Initially the ISSAC questionnaire was used to identify a possible asthma underreporting. 2007 Global Initiative for Asthma classification was used, which allowed clinically grouping minors into four categories. Finally, a questionnaire to identify risk factors was applied to the entire sample. Results: a hidden morbidity of 9.3 percent was identified. With mild intermittent asthma: 30 patients; mild persistent: 21; persistent moderate 28; and severe asthma: 14. All the patients had a family history of atopy, and crises were triggered by weather changes. 95.0 percent were sensitive to respiratory inhalants and 64.0 percent was detected to have smokers at home. Conclusions: bronchial Asthma persists as an underdiagnosed disease. Regarding the epidemiological aspect, family history of atopy and weather changes, outdid the other associated risk factors...
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Asthma/diagnosis , Asthma/epidemiology , Diagnostic Techniques, Respiratory System , Risk Factors , Cross-Sectional Studies , Epidemiology, DescriptiveABSTRACT
A prevalence study was carried out a rural community in Tiruvallur district in Tami Nadu to standardize the method of assessing an X-ray reader in tuberculosis (TB) prevalence surveys by means of different measures of agreement between the reader and a Standard Reader (SR). The exercise on assessing the X-ray readers was carried out on two occasions; one involving three trainee readers (R1, R2, and R3), and the other involving one trainee reader (R4). The extent of agreement was estimated using Kappa statistics (K), over-diagnosis, under-diagnosis, crude agreement and prevalence adjusted bias adjusted kappa (PABAK). The overall performance of readers R1, R2 and R3 was not satisfactory in terms of K (21, 34 and 14%) in the first assessment. The K, over-diagnosis and under-diagnosis were estimated to be 61, 28 and 4% for R1, 63, 18 and 4% for R2 and 58, 31 and 5% for R3 in the final assessment. This suggested that R2 performed well compared to the other two readers. The K was 68% for R4 in the first assessment. As the over-diagnosis was to the extent of 40%, the trainee reader underwent one more assessment. The K was 64% which was as good as before, but there was no improvement in the over-diagnosis (43.5%) in the second assessment. Based on the performance, only one reader (R2) was certified as qualified for X-ray reading in the first occasion while the reader (R4) assessed in the second occasion was not qualified. These findings were subject to the inherent variation in the SR’s readings against which the readers were assessed.