RESUMO

OBJECTIVE: To find evidence of the content, construct, and criterion validity of the LABIRINTO scale for the diagnosis of autism spectrum disorder (ASD) in children aged 24-59 months. METHODS: The scale was constructed in four stages: 1) items were defined based on an extensive literature review and discussions with autism and child development specialists; 2) child development specialists evaluated each item; 3) a preliminary version of the scale was applied to children diagnosed with ASD to enable any necessary adjustments; 4) the scale was then applied to 27 children with typical development and no neurodevelopmental disorder and 48 children with ASD. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Childhood Autism Rating Scale (CARS), clinical diagnosis constitutes the gold standard. RESULTS: The scale's psychometric indexes were appropriate for construct validity, with Kaiser-Meyer-Olkin = 0.94 and root mean square error of approximation = 0.000. Only one factor on the scale had a Cronbach alpha of 0.97. The receiver operating characteristic curve indicated a cutoff of 12, with a sensitivity of 100% and specificity of 100% for distinguishing children with ASD from those with typical development. CONCLUSION: This study confirmed the validity of the LABIRINTO scale.

Assuntos

RESUMO

RESUMEN Para lograr un análisis integral de los pacientes con trastorno por déficit de atención e hiperactividad, a partir de las insuficiencias en su diagnóstico, se asume como objetivo el proponer ejes de peritaje de los niños con esta dolencia, que aporten una compresión integral. Se concluye que un proceso de evaluación diagnóstica debe ser: exhaustivo, con enfoque a la potencialidad, personalizado, contextualizado, sistémico, con visión evolutiva y que considere la respuesta al tratamiento, lo cual se refleja en los ejes, en correspondencia con los síntomas nucleares predominantes, los trastornos mentales comórbidos, las alteraciones somáticas asociadas, los factores etiológicos identificados, el rendimiento escolar: las potencialidades socio-compensatorias, la respuesta al tratamiento, las características de los entornos de interacción, de acuerdo con la evolución, y el pronóstico del trastorno.

ABSTRACT To determine insufficiencies in the diagnostic evaluation of patients with attention deficit hyperactivity disorder, for a complete assessment. We propose axes for diagnostic evaluation of children with attention deficit hyperactivity disorder, for its better comprehension. We conclude that a diagnostic evaluation process of attention deficit hyperactivity disorder should be: comprehensive, focused on potential, personalized, contextualized, systemic, with an evolutionary vision including treatment response. In relation to predominant nuclear symptoms, axes reflect comorbid mental disorders, associated somatic alterations, etiological factors identified, school performance: socio-compensatory potential, response to treatment, characteristics of the interaction environments, evolution and prognosis of the disorder.

RESUMO

OBJECTIVE: To document the use of diagnostic testing in adolescents who ultimately were diagnosed with rumination syndrome, a functional gastrointestinal disorder. We examined the diagnostic yield of each test as well as the associated costs, and we determined if any demographic or illness-related variables impacted the magnitude of the work-up. STUDY DESIGN: A retrospective chart review was conducted for 68 patients with rumination syndrome admitted to our inpatient treatment program. The cost and findings of patients' diagnostic investigations were gathered, as well as demographic and illness-related variables to determine factors that may be related to evaluation size. RESULTS: The most commonly used tests in the evaluation of rumination syndrome included esophagogastroduodenoscopy, gastric emptying, antroduodenal manometry, upper gastrointestinal series, and abdominal ultrasound scan. Each patient underwent an average of 8.8 tests, with the average cost for each patient's diagnostic work-up being US $19 795. Few tests were found to be beneficial in the diagnosis of rumination syndrome, and few demographic or illness variables were found to be related to the overall extent of the investigation. CONCLUSIONS: Extensive testing for rumination syndrome in adolescents is common in clinical practice, and comes at a high financial cost with low yield, likely delaying diagnosis and treatment. Symptom-based criteria should be used to make the diagnosis of rumination syndrome.

Assuntos

RESUMO

La utilización de observaciones que proporcionan información acerca del funcionamiento sensorio-motor relacionado a procesamiento sensorial es común en la práctica clínica. Un grupo de observaciones, llamadas observaciones clínicas por A.J. Ayres ayuda a diagnosticar disfunciones sensoriales aunque no existen normas desarrolladas en Chile, ni su validez o confiabilidad establecida estadísticamente para su utilización. Para normar estas pruebas en Chile se entrenaron 4 evaluadores quienes recolectaron datos de niños entre 5 y 7.11 años de edad: 90 típicos y 26 identificados con problemas de procesamiento sensorial. Este estudio proporciona datos preliminares sobre 5 pruebas relacionadas a control postural y planeamiento motor: equilibrio en un pie (ojos cerrados y ojos abiertos), extensión antigravitatoria, flexion antigravitatoria, secuenciación de dígitos, y diadochokinesis. Los resultados indican que estas pruebas se pueden utilizar para diagnosticar niños con disfunciones sensorio-motoras en la práctica clínica e investigación.

Clinical observations that provide information about sensory-motor performance related to sensory processing, are commonly used in clinical practice. A group of these observations, known as clinical observations by A. J. Ayres,help diagnose sensory related dysfunctions even when normative data and statistically established validity and reliability are not available for the Chilean children. In order to develop normative data, we trained 4 independent assessors who collected data on 90 typically developing children 5 to 7.11 years of age and 26 children identified as presenting with sensory processing problems. The present study provides preliminary data about 5 observations that relate to postural control and motor planning: Standing on one foot (eyes open and closed), extensión against gravity, flexion against gravity, sequential finger touching and diadochokinesis. The results of this study indicate that these observations can help diagnose children with sensory-motor dysfunctions and be utilized for clinical applications and research.

Assuntos

RESUMO

ResumenIntroducción: La prueba Evaluación del Desarrollo Infantil (EDI), diseñada en México, clasifica a los niños de acuerdo con su desarrollo en desarrollo normal, rezago en el desarrollo y riesgo de retraso. La versión modificada se desarrolló y validó, pero no se conocen sus propiedades en base poblacional. El objetivo de este trabajo fue establecer la confirmación diagnóstica en niños de 16 a 59 meses identificados con riesgo de retraso por la prueba EDI.Métodos: Se realizó un estudio transversal de base poblacional en una entidad federativa de México. Se aplicó la prueba EDI a 11,455 niños de 16 a 59 meses, de diciembre de 2013 a marzo de 2014. Se consideró como población elegible al 6.2% (n = 714) que obtuvo como resultado riesgo de retraso. Para la inclusión en el estudio se realizó una aleatorización estratificada por bloques para sexo y grupo de edad. A cada participante se le realizó la evaluación diagnóstica utilizando el Inventario de Desarrollo de Battelle 2ª. edición.Resultados: De los 355 participantes incluidos, el 65.9% fue de sexo masculino y el 80.2% de medio rural. El 6.5% fueron falsos positivos (cociente total de desarrollo ¿ 90) y el 6.8% no tuvo ningún dominio con retraso (cociente de desarrollo de dominio < 80). Se calculó la proporción de retraso en las siguientes áreas: comunicación (82.5%), cognitivo (80.8%), personal-social (33.8%), motor (55.5%) y adaptativo (41.7%). Se observaron diferencias en los porcentajes de retraso por edad y dominio/subdominio evaluado.Conclusiones: Se corroboró la presencia de retraso en al menos un dominio evaluado por la prueba diagnóstica en el 93.2% de la población estudiada.

AbstractBackground: The Child Development Evaluation (or CDE Test) was developed in Mexico as a screening tool for child developmental problems. It yields three possible results: normal, slow development or risk of delay. The modified version was elaborated using the information obtained during the validation study but its properties according to the base population are not known. The objective of this work was to establish diagnostic confirmation of developmental delay in children 16- to 59-months of age previously identified as having risk of delay through the CDE Test in primary care facilities.Methods:A population-based cross-sectional study was conducted in one Mexican state. CDE test was administered to 11,455 children 16- to 59-months of age from December/2013 to March/2014. The eligible population represented the 6.2% of the children (n = 714) who were identified at risk of delay through the CDE Test. For inclusion in the study, a block randomization stratified by sex and age group was performed. Each participant included in the study had a diagnostic evaluation using the Battelle Development Inventory, 2nd edition.Results: From the 355 participants included with risk of delay, 65.9% were male and 80.2% were from rural areas; 6.5% were false positives (Total Development Quotient ¿90) and 6.8% did not have any domain with delay (Domain Developmental Quotient <80). The proportion of delay for each domain was as follows: communication 82.5%; cognitive 80.8%; social-personal 33.8%; motor 55.5%; and adaptive 41.7%. There were significant differences in the percentages of delay both by age and by domain/subdomain evaluated.Conclusions: In 93.2% of the participants, developmental delay was corroborated in at least one domain evaluated.

RESUMO

Intracerebral hemorrhage (ICH) is a devastating condition with multiple possible underlying causes. Early diagnosis of ICH associated with a precise diagnostic work-up is mandatory. Clinical signs may give clues to diagnosis but are not reliable enough and imaging remains the cornerstone of management. Noncontrast computed tomography and magnetic resonance imaging (MRI) are highly sensitive for ICH identification. Additionally, MRI may disclose brain parenchymal biomarkers that can contribute to the etiologic diagnosis. Vessel examination should be carried out whenever there is a clinical suspicion of underlying structural lesions, such as vascular malformations or tumors. To date, conventional angiography remains the gold standard to detect intracranial vascular malformations in patients with ICH.

Assuntos

RESUMO

BACKGROUND: The Child Development Evaluation (or CDE Test) was developed in Mexico as a screening tool for child developmental problems. It yields three possible results: normal, slow development or risk of delay. The modified version was elaborated using the information obtained during the validation study but its properties according to the base population are not known. The objective of this work was to establish diagnostic confirmation of developmental delay in children 16- to 59-months of age previously identified as having risk of delay through the CDE Test in primary care facilities. METHODS: A population-based cross-sectional study was conducted in one Mexican state. CDE test was administered to 11,455 children 16- to 59-months of age from December/2013 to March/2014. The eligible population represented the 6.2% of the children (n=714) who were identified at risk of delay through the CDE Test. For inclusion in the study, a block randomization stratified by sex and age group was performed. Each participant included in the study had a diagnostic evaluation using the Battelle Development Inventory, 2nd edition. RESULTS: From the 355 participants included with risk of delay, 65.9% were male and 80.2% were from rural areas; 6.5% were false positives (Total Development Quotient ˃90) and 6.8% did not have any domain with delay (Domain Developmental Quotient <80). The proportion of delay for each domain was as follows: communication 82.5%; cognitive 80.8%; social-personal 33.8%; motor 55.5%; and adaptive 41.7%. There were significant differences in the percentages of delay both by age and by domain/subdomain evaluated. CONCLUSIONS: In 93.2% of the participants, developmental delay was corroborated in at least one domain evaluated.

RESUMO

Para elevar la calidad del posgrado se expone la utilidad de la aplicación de evaluaciones diagnósticas en los programas referidos a temas de cirugía laparoscópica y endoscopia digestiva. Se dio respuesta a la interrogante que refiere si existen diferencias de niveles de formación previa, en los alumnos de posgrado del Centro Nacional de Cirugía de Mínimo Acceso (CNCMA), al identificar las desigualdades de los que matricularon en 6 programas de estudio de posgrado en los años 2010 y 2011. Se aplicaron pruebas diagnósticas que permitieron ponderar los errores cometidos por los estudiantes en las temáticas de los programas de posgrado a impartir, detectando diferencias en las condiciones cognoscitivas iniciales en el período analizado. Los porcentajes generales de errores se presentaron por debajo del 50 por ciento con la excepción del Curso de Cirugía laparoscópica ginecológica que tuvo un 51 por ciento general de errores. Los resultados avalaron la pertinencia de la aplicación de las pruebas diagnósticas para permitir que los profesores puedan saber qué grado de conocimientos previos poseen los alumnos, necesarios para asimilar los contenidos de los programas docentes y en qué grado pueden haber alcanzado ya los objetivos propuestos en dichos programas

For the purpose of increasing the quality of postgraduate education, this paper presented the advantages of diagnostic evaluations in the programs including topics of laparoscopic surgery and digestive endoscopy. It gave response to the question of whether there are differences in the previous levels of formation of undergraduate students of the National Center of Minimum Access Surgery by way of identifying the inequalities among those who registered for 6 postgraduate studies in 2010 and 2011. Diagnostic tests were applied, which allowed weighing the mistakes made by the students in postgraduate topics and detecting the differences in the initial cognitive conditions during the analyzed period. The general percentages of mistakes were under 50 percent, except for the laparoscopic gynecological surgery course that showed 51 percent of mistakes. The results supported the importance of using diagnostic tests so that the professor can know in advance the level of knowledge of the participating students to assimilate the contents of the educational programs, and also to what extent they could have reached the objectives put forward in these programs

Assuntos

RESUMO

A proposta deste artigo é considerar as reflexões e análise de pesquisa, tendo em vista a avaliação e intervenção psicopedagógica institucional, a partir de uma pesquisa e projeto desenvolvido para a realização da monografia que construí no curso de Especialização em Psicopedagogia Clínica e Institucional, da Universidade Vale do Acaraú - UVA/CE (2003), resultado do trabalho que desenvolvi no estágio institucional em 2002, no LCDS (ONG), instituição que trabalha com reforço escolar, formação religiosa e cidadã das crianças carentes, do bairro Vila União, em Fortaleza/CE, e que são oriundas de escolas públicas regulares. Com a intervenção psicopedagógica, as professoras passaram a compreender a construção do processo ensino-aprendizagem e a perceber que as dificuldades relativas ao crescimento do aprendiz resultam da interferência de fatores biológicos, psicológicos, pedagógicos, psicopedagógicos e socioculturais, muitas vezes originados no seio da família, sendo, às vezes, mantidos e reproduzidos pela instituição escolar. Passaram a olhar as crianças com um NOVO OLHAR, sem rótulos e sem preconceitos, valorizando suas diferenças, seu nível de letramento, sua história de vida, sua modalidade de aprendizagem e a forma de se expressar, resultando na melhoria da aprendizagem escolar no curto prazo. Espera-se, com este artigo, poder contribuir com a práxis psicopedagógica no contexto escolar, tanto na avaliação diagnóstica, quanto na fase de intervenção.(AU)

The proposal of this article is to consider the reflections and research analysis, in view of psychopedagogic evaluation and institutional intervention, from a research and project developed for the monograph accomplishment constructed through the course of Specialization in Clinical and Institutional Psychopedagogy, at the Universidade Vale do Acaraú - UVA/CE (2003), result of a work developed in the institutional period of training, in 2002, at LCDS (NGO), an institution which works with school reinforcement pertaining, religious formation and citizenship to the devoid children from the quarter of Vila União, in Fortaleza/CE, and which are derived of regular public schools. Through psychopedagogic intervention, the teachers had started to understand the construction of teach-learning process and perceived that the relative difficulties to apprentice growth result from the interference of biologic, psychologic, pedagogic, psychopedagogic and sociocultural factors, many times originated within ones family, being, at times, kept and reproduced by the school institution. They got seeing the children with a NEW LOOK, without labels and preconceptions, valuing their differences, letramento level, life history, learning modality and form of self-expressing, turning out to improvement of school learning at short term. One hopes, through this article, being able to contribute with the psychopedagogical praxis in the school context, both in the diagnostic evaluation and in the intervention phase.(AU)