Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20.655
Filtrar
2.
Nursing ; 50(2): 48-55, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31977806

RESUMEN

Low back pain (LBP) is one of the most frequent patient complaints in primary care. This article discusses the assessment and treatment of patients with LBP, including nonpharmacologic and pharmacologic approaches.


Asunto(s)
Dolor de la Región Lumbar/enfermería , Atención Primaria de Salud , Adulto , Humanos , Anamnesis , Evaluación en Enfermería , Examen Físico/enfermería , Factores de Riesgo
4.
Lancet ; 395(10217): 24-25, 2020 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-31982047
5.
BJOG ; 127(3): 364-375, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31507061

RESUMEN

OBJECTIVE: Unselected population-based BRCA testing provides the opportunity to apply genomics on a population-scale to maximise primary prevention for breast-and-ovarian cancer. We compare long-term outcomes of population-based and family-history (FH)/clinical-criteria-based BRCA testing on psychological health and quality of life. DESIGN: Randomised controlled trial (RCT) (ISRCTN73338115) GCaPPS, with two-arms: (i) population-screening (PS); (ii) FH/clinical-criteria-based testing. SETTING: North London Ashkenazi-Jewish (AJ) population. POPULATION/SAMPLE: AJ women/men. METHODS: Population-based RCT (1:1). Participants were recruited through self-referral, following pre-test genetic counselling from the North London AJ population. INCLUSION CRITERIA: AJ women/men >18 years old; exclusion-criteria: prior BRCA testing or first-degree relatives of BRCA-carriers. INTERVENTIONS: Genetic testing for three Jewish BRCA founder-mutations: 185delAG (c.68_69delAG), 5382insC (c.5266dupC) and 6174delT (c.5946delT), for (i) all participants in PS arm; (ii) those fulfilling FH/clinical criteria in FH arm. Linear mixed models and appropriate contrast tests were used to analyse the impact of BRCA testing on psychological and quality-of-life outcomes over 3 years. MAIN OUTCOME MEASURES: Validated questionnaires (HADS/MICRA/HAI/SF12) used to analyse psychological wellbeing/quality-of-life outcomes at baseline/1-year/2-year/3-year follow up. RESULTS: In all, 1034 individuals (691 women, 343 men) were randomised to PS (n = 530) or FH (n = 504) arms. There was a statistically significant decrease in anxiety (P = 0.046) and total anxiety-&-depression scores (P = 0.0.012) in the PS arm compared with the FH arm over 3 years. No significant difference was observed between the FH and PS arms for depression, health-anxiety, distress, uncertainty, quality-of-life or experience scores associated with BRCA testing. Contrast tests showed a decrease in anxiety (P = 0.018), health-anxiety (P < 0.0005) and quality-of-life (P = 0.004) scores in both PS and FH groups over time. Eighteen of 30 (60%) BRCA carriers identified did not fulfil clinical criteria for BRCA testing. Total BRCA prevalence was 2.9% (95% CI 1.97-4.12%), BRCA1 prevalence was 1.55% (95% CI 0.89-2.5%) and BRCA2 prevalence was 1.35% (95% CI 0.74-2.26%). CONCLUSION: Population-based AJ BRCA testing does not adversely affect long-term psychological wellbeing or quality-of-life, decreases anxiety and could identify up to 150% additional BRCA carriers. TWEETABLE ABSTRACT: Population BRCA testing in Ashkenazi Jews reduces anxiety and does not adversely affect psychological health or quality of life.


Asunto(s)
Ansiedad , Detección Precóz del Cáncer , Genes BRCA1 , Genes BRCA2 , Síndrome de Cáncer de Mama y Ovario Hereditario , Calidad de Vida , Adulto , Ansiedad/fisiopatología , Ansiedad/prevención & control , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/psicología , Femenino , Predisposición Genética a la Enfermedad/psicología , Pruebas Genéticas/métodos , Pruebas Genéticas/estadística & datos numéricos , Síndrome de Cáncer de Mama y Ovario Hereditario/diagnóstico , Síndrome de Cáncer de Mama y Ovario Hereditario/etnología , Síndrome de Cáncer de Mama y Ovario Hereditario/genética , Síndrome de Cáncer de Mama y Ovario Hereditario/psicología , Humanos , Judíos/genética , Judíos/estadística & datos numéricos , Londres/epidemiología , Masculino , Anamnesis/estadística & datos numéricos , Incertidumbre
6.
Int J Cancer ; 146(3): 627-634, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30868574

RESUMEN

Early detection of colorectal neoplasms can reduce the disease burden of colorectal cancer by timely intervention of individuals at high risk. Our aim was to evaluate a joint environmental-genetic risk score as a risk stratification tool for early detection of advanced colorectal neoplasm (ACRN). Known environmental risk factors and high-risk genetic loci were summarized into risk scores for ACRN in 1014 eligible participants of a screening study. The performances of single and joint environmental-genetic scores were evaluated with estimates and 95% confidence intervals (CI) of the absolute risk, relative risk and predictive ability using the area under the curve (AUC). Individuals with higher environmental risk scores showed increasing ACRN risk, with 3.1-fold for intermediate risk and 4.8-fold for very high risk, compared to the very low environmental risk group. Similarly, individuals with higher genetic risk scores showed increasing ACRN risk, with 2.2-fold for intermediate risk and 3.5-fold for very high risk, compared to the lowest genetic risk group. Moreover, the joint environmental-genetic score improved the ACRN risk stratification and showed higher predictive values (AUC = 0.64; 95%CI = 0.60-0.67) with substantial difference (p = 0.0002) compared to the single environmental score (0.58; 0.55-0.62). The integration of environmental and genetic factors looks promising for improving targeting individuals at high-risk of colorectal neoplasm. Applications in practical screening programs require optimization with additional genetic and other biomarkers involved in colorectal carcinogenesis.


Asunto(s)
Neoplasias Colorrectales/epidemiología , Detección Precóz del Cáncer/estadística & datos numéricos , Factores de Edad , Anciano , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Femenino , Sitios Genéticos/genética , Predisposición Genética a la Enfermedad , Alemania/epidemiología , Humanos , Estilo de Vida , Masculino , Anamnesis , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo/métodos , Factores de Riesgo
7.
Int J Cancer ; 146(3): 791-802, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30980537

RESUMEN

Perinatal factors have been associated with soft tissue sarcomas (STS) in case-control studies. However, (i) the contributions of factors including fetal growth remain unknown, ( ii) these factors have not been examined in cohort studies and (iii) few assessments have evaluated risk in specific STS subtypes. We sought to identify the role of perinatal and familial factors on the risk of STS in a large population-based birth cohort. We identified 4,023,436 individuals in the Swedish Birth Registry born during 1973-2012. Subjects were linked to the Swedish Cancer Registry, where incident STS cases were identified. We evaluated perinatal and familial factors obtained from Statistics Sweden, including fetal growth, gestational age, and presence of a congenital malformation. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for associations between perinatal factors and STS overall, as well as by common subtypes. There were 673 individuals diagnosed with STS in 77.5 million person-years of follow-up. Having a congenital malformation was associated with STS (IRR = 1.70, 95% CI: 1.23-2.35). This association was stronger (IRR = 2.90, 95% CI: 1.25-6.71) in recent years (2000-2012). Low fetal growth was also associated with STS during the same time period (IRR = 1.86, 95% CI: 1.05-3.29). Being born preterm was associated with rhabdomyosarcoma (IRR = 1.74, 95% CI: 1.08-2.79). In our cohort study, those with congenital malformations and other adverse birth outcomes were more likely to develop a STS compared to their unaffected contemporaries. These associations may point to disrupted developmental pathways and genetic factors influencing the risk of STS.


Asunto(s)
Anomalías Congénitas/epidemiología , Nacimiento Prematuro/epidemiología , Sarcoma/epidemiología , Adolescente , Adulto , Niño , Preescolar , Comorbilidad , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Edad Gestacional , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Anamnesis/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Sarcoma/genética , Suecia/epidemiología , Adulto Joven
8.
Rev Med Liege ; 74(12): 655-661, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31833276

RESUMEN

The diagnosis of inherited platelet disorders (IPD) is a complex task. Indeed, due to their rarity, their wide clinical spectrum (intensity of hemorrhagic symptoms) and the need for specialized biological assays (only performed in reference centers) IPDs can be diagnosed very late. However, it is important to remember the crucial need for early diagnosis in order to avoid the use of unnecessary and potentially harmful treatments for the patient. A thorough personal and family history, a complete physical examination and a simple biological work up (blood count, blood smear and platelet occlusion time) will lead to the suspicion of an IPD. It will then be up to the physician to refer the patient to a specialist in order to complete the diagnostic work up and therefore establishing a definitive diagnosis. Here is a description of the most well-known IPDs and their diagnostic algorithms.


Asunto(s)
Trastornos de las Plaquetas Sanguíneas , Algoritmos , Trastornos de las Plaquetas Sanguíneas/diagnóstico , Plaquetas , Hemorragia , Humanos , Anamnesis
9.
Anticancer Res ; 39(12): 6859-6862, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810953

RESUMEN

BACKGROUND/AIM: Hodgkin's lymphoma (HL) accounts for 1% of cancers and is of largely unknown pathogenesis. This study intended to find clues about potential causes (etiology) of HL through observations on patients and their families. PATIENTS AND METHODS: In 37 years of a medical oncology practice in Basel, Switzerland, 36 out of 2201 patients (1.6%) had HL. Etiological information has been obtained from the patients with the help of a German translation of the NCI Medical History Questionnaire for Cancer Etiology, and through the study of their medical charts. RESULTS: Findings of etiological interest were observed in the medical history of 26 out of the 36 patients with HL; these findings were grouped as follows: benign tumors (25%), carcinogenic exposures (19%), immunologic disorders (19%), secondary malignancies (14%), infections (11%), congenital disorders (8%) and tonsillectomies (6%). Twenty-two out of 36 patients had one or more relatives with cancer. CONCLUSION: Personal and family history of patients with HL is a readily available useful tool for etiology research. The fact that HL is frequently associated with other cancers in patients and their relatives points to causal genetic factors.


Asunto(s)
Enfermedad de Hodgkin/etiología , Enfermedad de Hodgkin/mortalidad , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , Factores de Riesgo , Suiza/epidemiología , Adulto Joven
10.
Medicine (Baltimore) ; 98(51): e18315, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860982

RESUMEN

The incidence of breast cancer among Japanese women is substantially increasing. This study evaluated the effects of reproductive and lifestyle factors with respect to breast cancer overall and separately among pre- and postmenopausal women using data from the Three-Prefecture Cohort Study of Japan.A total of 33,410 women aged 40 to 79 years completed a self-administered questionnaire, which included items about menstrual and reproductive history and other lifestyle factors. The follow-up period was from 1984 to 1992 in Miyagi and 1985 to 2000 in Aichi Prefectures. We used Cox proportional hazards regression models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors.After 9.8 mean years of follow-up, 287 cases of breast cancer were recorded. In the overall analysis, later menarche (≥16 years) and parity were significantly associated with a decreased risk of breast cancer, with HRs of 0.69 (95% CI 0.48-0.99) and 0.72 (95% CI 0.52-0.99), respectively. Further, there was a significant decline in the risk of breast cancer with increasing number of birth among parous women (P for trend = .010). On the contrary, a family history of breast cancer in the mother was significantly associated with an increased risk of breast cancer (HR 3.22, 95% CI 1.52-6.84). Analyses based on menopausal status at baseline indicated that height (≥160 cm) and weight (≥65 kg) were significantly associated with an increased risk of postmenopausal breast cancer, with HRs of 1.34 (95% CI 0.72-2.50) and 3.13 (95% CI 1.75-5.60), respectively. Risk associated with BMI significantly differs by menopausal status.Our findings suggest the important role of reproductive factors in the development of breast cancer in Japanese women; however, body mass index (BMI) may have different effects on breast cancer in Japanese women compared with western women.


Asunto(s)
Neoplasias de la Mama/etiología , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/genética , Estudios de Cohortes , Femenino , Humanos , Japón/epidemiología , Estilo de Vida , Anamnesis , Menarquia , Persona de Mediana Edad , Paridad , Factores de Riesgo , Encuestas y Cuestionarios
11.
Presse Med ; 48(11 Pt 1): 1229-1236, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31732360

RESUMEN

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis.


Asunto(s)
Cannabis/efectos adversos , Abuso de Marihuana/complicaciones , Psicosis Inducidas por Sustancias/etiología , Factores de Edad , Encéfalo/efectos de los fármacos , Endocannabinoides/fisiología , Predisposición Genética a la Enfermedad , Humanos , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Anamnesis , Psicosis Inducidas por Sustancias/prevención & control , Riesgo
12.
Rev Med Liege ; 74(11): 616-619, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31729852

RESUMEN

Inherited platelet disorders (IPD) include a set of rare diseases whose diagnosis is often difficult because it requires the use of complex biological assays in specialized centers. They are probably under-diagnosed. Clinicians should consider an IPD when facing a chronic thrombocytopenia resistant to intravenous immunoglobulins (IVIG) and steroids together with a family history of thrombocytopenia. A syndromic thrombocytopenia will be suspected by the family survey and specific clinical signs. The confirmation of the diagnosis will then require the use of specialized biological assays such as platelet aggregation, flow cytometry, electron microscopy, platelet secretion assays, karyotype and molecular biology.


Asunto(s)
Trombocitopenia , Humanos , Inmunoglobulinas Intravenosas , Anamnesis , Recuento de Plaquetas , Trombocitopenia/diagnóstico , Trombocitopenia/genética , Trombocitopenia/terapia
13.
BMJ ; 367: l5784, 2019 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-31645334

RESUMEN

OBJECTIVE: To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. DESIGN: Population and sibling matched cohort study. SETTING: Swedish population. PARTICIPANTS: 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. MAIN OUTCOME MEASURES: A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. RESULTS: The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. CONCLUSION: In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.


Asunto(s)
Infecciones Bacterianas/epidemiología , Susceptibilidad a Enfermedades/inmunología , Trastornos de Estrés Traumático/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/inmunología , Niño , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Anamnesis , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Hermanos , Trastornos de Estrés Traumático/inmunología , Tasa de Supervivencia , Suecia/epidemiología , Adulto Joven
14.
BMC Infect Dis ; 19(1): 915, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31664936

RESUMEN

BACKGROUND: A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. METHODS: A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. RESULTS: Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28-15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88-6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17-0.73]}. CONCLUSIONS: Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.


Asunto(s)
Diabetes Mellitus/epidemiología , Tamizaje Masivo , Tuberculosis/epidemiología , Adulto , Glucemia/análisis , Estudios Transversales , Diabetes Mellitus/sangre , Femenino , VIH/inmunología , Seropositividad para VIH , Humanos , Modelos Logísticos , Masculino , Anamnesis , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Esputo/microbiología , Encuestas y Cuestionarios , Tanzanía/epidemiología , Tuberculosis/virología , Adulto Joven
16.
J Drugs Dermatol ; 18(10): 1049-1052, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31603634

RESUMEN

Drug re-exposure resulting in Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is a rare phenomenon and has scarcely been reported. With an aging population, polypharmacy, and a lack of a unified electronic medical record, standard recommendations to prevent or minimize the risk of re-exposure are necessary. We identified five patients, with diagnosis confirmed SJS/TEN, and determined the clinical characteristics and contributing risk factors leading to re-exposure. Polypharmacy, multiple prescribers, advanced age, medical illiteracy, retention of discontinued medications and self-prescribing all contributed to re-exposure in this cohort of patients. This case series demonstrates the potentially deadly effect of drug re-exposure, and the need for both streamlined and integrated medication allergy documentation systems. J Drugs Dermatol. 2019;18(10):1049-1052.


Asunto(s)
Anamnesis , Conciliación de Medicamentos , Síndrome de Stevens-Johnson/prevención & control , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retratamiento/efectos adversos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiología , Adulto Joven
17.
Nature ; 574(7778): 296, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31619798
18.
Med Clin North Am ; 103(6): 957-966, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582006

RESUMEN

The collection of family history has always been a tool for genetic evaluation, but it remains an essential tool even in the age of genomic medicine. Patients may have a risk for a disease based on family history regardless of the results of genetic and genomic tests. How this information is collected is less important than that relevant information is collected in the first place. There are many tools for collecting medical and family history information both by hand and electronically. Genetic and genomic testing should always be interpreted in the context of the personal and family history.


Asunto(s)
Pruebas Genéticas/métodos , Anamnesis/métodos , Medicina de Precisión , Humanos , Linaje , Medición de Riesgo
19.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31548334

RESUMEN

Pediatricians and other pediatric primary care providers may be consulted when families have concerns that their child is not making expected progress in school. Pediatricians care not only for an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties but also for increasing numbers of children with complex and chronic medical problems that can affect the development of the central nervous system and can present with learning and academic concerns. In many instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients. Our purpose for this report is to describe the current state of the science regarding educational achievement to inform pediatricians' decisions regarding further evaluation of a child's challenges. In this report, we review commonly available options for psychological evaluation and/or treatment, medical referrals, and/or recommendations for referral for eligibility determinations at school and review strategies for collaborating with families, schools, and specialists to best serve children and families.


Asunto(s)
Rendimiento Académico , Pediatras , Rol del Médico , Niño , Defensa del Niño , Diagnóstico Diferencial , Diagnóstico Precoz , Educación Especial/legislación & jurisprudencia , Humanos , /prevención & control , Anamnesis , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/terapia , Privacidad/legislación & jurisprudencia , Derivación y Consulta , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA