Confiabilidade e validade da palidez palmar e de conjuntivas como triagem de anemia

OBJECTIVE: To evaluate the reliability and the validity of the use of simple clinical signs as a method of anemia detection. METHODS: The study was carried out in a São Paulo, Brazil, day-care center, and included 135 children from ages 3 months-6 years. Hemoglobin level results and palmar and conjunctival pallor assessment were used. Children with Hb under 11g/dl were considered as anemic; subjective criteria were used for the assessment of palmar and conjunctival pallor. Kappa statistics were used in order to verify agreement, and, in order to evaluate the technique's validity, sensitivity and specificity levels were calculated. RESULTS: The results show low levels of agreement. There was a greater level of sensitivity to conjunctival pallor than to palmar pallor. Specificity results may be considered as good. CONCLUSIONS: It is still early to recommend the routine use of this technique. However, it could promote substantial savings if perfected.OBJETIVO: Avaliar a confiabilidade e a validade do uso de sinais clínicos simples de palidez palmar e de conjuntivas, como método para triagem de anemia. MÉTODOS: Estudo realizado em uma creche municipal de São Paulo, SP, com 135 crianças >;3 meses

Validity and Reliability of the Frontotemporal Dementia Rating Scale (FTD-FRS) for the Progression and Staging of Dementia in Brazilian Patients

Introduction: Few studies on instruments for staging frontotemporal dementia (FTD) have been conducted.  Objective: The objective of this study was to analyze the factor structure, internal consistency, reliability, and convergent validity of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS).  Methods: A total of 97 individuals aged 40 years and above with >2 years’ education took part in the study, 31 patients diagnosed with behavioral variant FTD (bvFTD), 8 patients with primary progressive aphasia, 28 with Alzheimer disease, 8 with mild cognitive impairment, and a control group of 22 healthy subjects. The FTD-FRS was completed by family members or caregivers, and Neurologists completed the 8-item Clinical Dementia Rating for Frontotemporal Lobar Degeneration (CDR-FTLD) scale (6 original domains plus Language and Behavior). The Alzheimer disease and FTD patients had equivalent disease severity level.  Results: The internal consistency of the FTD-FRS, estimated by Cronbach α, was 0.975 whereas test-retest reliability was 0.977. Scree plot and exploratory factor (Varimax rotation) analyses revealed the existence of 4 factors, with eigenvalues >1, which together explained 77.13% of the total variance with values of 1.28 to 17.52. The domains of the Brazilian version of the FTD-FRS scale correlated with the domains of the CDR-FTLD.  Conclusions: The present study is the first to document the factorial structure of the FTD-FRS and its convergent validity with the CDR-FTLD. These tools are key to determine dementia severity in FTD. The Brazilian FTD-FRS demonstrated adequate psychometric properties for use in Brazil. This instrument may contribute to disease staging in FTD and may help to document intervention-related changes

Levels of exposure to organochlorine pesticides in open-air dump dwellers

OBJECTIVE: To estimate the degree of internal exposure to organochlorine pesticides (persistent organic pollutants, POP) among inhabitants of an open-air dump. METHODS: This was an observational study with simultaneous measurement and control, in which the criterion for subjects was that they dwelled in an area contaminated by POP and the effect of such contamination was the concentration of such substances into the blood. The study population consisted of 238 people living on an open-air dump in Pilões, in the municipality of Cubatão, SP, Brazil, and the control population was formed by 258 people, also resident in that municipality, in the Cota 200 district. The following pesticides were analysed: hexachlorobenzene (HCB), p-p'DDT, p-p'DDE, p-p'DDD, o-p'DDT, a HCH (hexachlorocyclohexane); b HCH; g HCH; aldrin; dieldrin; endrin; heptachlor; heptachlor-epoxy and mirex. RESULTS: The average blood level of HCB in Pilões was 4.66 µg/l, which was 155 times higher than the average for Cota 200 (0.03 µg/l). In Pilões the average blood concentration of total DDT was 3.71 µg/l, which was twice the level found in Cota 200 (1.85 µg/l). Total HCH presented blood concentrations that were six times greater in Pilões (0.84 µg/l versus 0.13 µg/l). CONCLUSIONS: A positive association was shown between dwelling in Pilões and the presence of POP in the blood, with much higher risks than in localities without the presence of these contaminants.OBJETIVO: Estimar o grau de exposição interna aos praguicidas organoclorados (POP) dos moradores de um atêrro a céu aberto. MÉTODOS: Estudo observacional, de aferição simultânea e controlado, cujo fator de estudo foi residir em área contaminada por POP e o efeito foi a concentração sanguínea dessas substâncias. A população de estudo foi de 238 pessoas residentes em um aterro a céu aberto (Pilões), no município de Cubatão, SP; e a população de controle ficou dimensionada em 258 pessoas, também residentes no mesmo município (Cota 200). Foram analisados os praguicidas HCB, p-p'DDT, p-p'DDE, p-p'DDD, o-p'DDT, a HCH; b HCH; g HCH; Aldrin; Dieldrin; Endrin; Heptaclor; Heptaclor-epoxi e Mirex. RESULTADOS: Os teores médios sangüíneos de HCB em Pilões foram de 4,66 µg/L, 155 vezes maior que a média na Cota 200 (0,03 µg/L). Em Pilões, os teores médios de DDT total foram de 3,71 µg/L, duas vezes maior do que na Cota 200 (1,85 µg/L) e o HCH total apresentou concentrações sangüíneas seis vezes maiores em Pilões, 0,84 µg/L, contra 0,13 µg/L. CONCLUSÕES: Evidenciou-se associação positiva entre residir em Pilões e apresentar teores sangüíneos de POP, com risco muitas vezes maior quando comparado a localidades sem a presença desses contaminantes

Study of the intelligence of schizophrenic patients based on the Weschler scale

O desempenho cognitivo (DC) de 25 esquizofrênicos ambulatoriais diagnosticados pelos critérios da DSM-III-R é comparado com o de 28 controles sadios, balanceados por idade e educação. O desempenho cognitivo foi medido pela Escala de Inteligência para Adultos de Weschler, em sua versão portuguesa (WAIS), aplicado fora da fase aguda. Os resultados do WAIS apontam para um déficit cognitivo nos esquizofrênicos, comparados com os controles. A diferença foi mais acentuada nos aspectos de inteligência associados à atenção, concentração, percepção e uso de conceitos. Estes achados são reforçados por achados prévios, de um padrão de déficit neuropsicol6gico de inteligência em esquizofrenia. Estes déficits, devidamente quantificados, podem servir de auxílio no planejamento de tratamento, treinamento de habi lidades sociais e redução de stress em esquizofrênicos.The cognitive performance of 25 male DSM-III-R schizophrenic outpatients is compared with 28 healthy controls balanced for age and education. It was employed the Portuguese version of WAIS (Weschler Intelligence Scale for Adulls). Overall kappas for psychiatric diagnosis was 0.86; WAIS was applied to patients out of acute phase. Results point to a significant diminution in cognitive functioning of schizophrenic compared to controls. This difference was more pronounced on aspects of intelligence linked to atention, concentration, perception and use of concepts. These data are supporled by previous findings of an overall palient of neurapsychological deficit in specific functions of intelligence in schizophrenia. The focus on cognitive deficit points to the use of standardized assessment of intelligence for treatment, planning social skills training and stress reduction in schizophrenia