Sustained attention in school-age children with congenital hypothyroidism: Influence of episodes of overtreatment in the first three years of life. / Atención sostenida en niños con hipotiroidismo congénito en edad escolar. Influencia de los episodios de sobretratamiento en los primeros 3 años de vida.

INTRODUCTION: Children with congenital hypothyroidism (CH) are at risk of developing mild cognitive impairment despite normal overall intellectual performance. These deficits may be caused by disease-related and treatment-related factors. This study explores the impact of abnormal thyroid function during the first 3 years of life on attention performance at school age. METHODS: We included 49 children diagnosed with CH and receiving treatment for the condition: 14 boys (mean age 9.5±2.8 years) and 35 girls (9.6±2.6 years). The number of episodes of normal, under-, and overtreatment were estimated based on TSH levels during their first 3 years of life (at 12, 18, 24, 30, and 36 months). Children were assessed using a computerised version of a Sustained attention test. General linear models were calculated with the attention index as the dependent variable and sex, aetiology, and number of episodes of normal, under-, and overtreatment as independent variables. RESULTS: Higher numbers of episodes of overtreatment (low TSH level) were associated with poorer attention performance at school age (P=.005, r=-0.45). CONCLUSIONS: Children with CH should be monitored closely during the first 3 years of life in order to prevent not only hypothyroidism but also any adverse effects of overtreatment that may affect attentional function at school age.

Automated angiodysplasia detection from wireless capsule endoscopy.

We present a novel system for the automatic detection of angiodysplasia lesions from capsule endoscopy images. The approach identifies potential regions of interest and classifies them using a combination of color-based, texture, statistical and morphological features. A boosted decision tree classification method is used in order to overcome the problem of unbalanced sampling between pathological and non-pathological regions. The lesion detection method has been designed and validated using a lesion database labelled by an expert. The approach achieves a sensitivity of 89.51% and a specificity of 96.8%, thus providing a high performance in the detection of angiodysplasia lesions.

Escala de calidad de vida para el ictus (ECVI-38): evaluación de su aceptabilidad, fiabilidad y validez / Stroke-specific quality of life scale (ecvi-38): an evaluation of its acceptance, reliability and validity

Introducción y objetivos. La calidad de vida relacionada con la salud (CVRS) actualmente es clave en la evaluación de ensayos clínicos para el ictus. Las escalas ictus específicas existentes se desarrollaron en países anglosajones y la mayoría no reúnen los requisitos de validez necesarios. Por ello, se desarrolló la primera escala hispana para evaluar calidad de vida (CV) en sobrevivientes a un ictus (ECVI-38). En este trabajo se evaluaron las propiedades psicométricas de esta medida resumen. Pacientes y métodos. Se estudiaron 63 pacientes con ictus, entre 2 meses y 2años de su ocurrencia, para evaluar la aceptabilidad, fiabilidad yla validez de la ECVI-38, con la utilización de métodos psicométricos estandarizados. Resultados. La ECVI-38 demostró buena aceptabilidad; solamente tres elementos tuvieron alto porcentaje de datos perdidos debido a la edad de los pacientes de la muestra; los efectos piso y techo estuvieron dentro de los límites aceptados. La escala mostró buena consistencia interna ( α de Cronbach0,79-0,97, correlaciones interelemento 0,53-0,90) y buena estabilidad en la prueba test-retest (coeficientes de correlación intraclase0,89-0,98). En cuanto a su validez de construcción (correlacion estotales entre dominios correctas, r = 0,57-0,90 convergente ,r = 0,19-0,39 discriminante), sus resultados fueron muy buenos; así como los estudios de validez contra criterio externo (diferencia entre grupos con estado neurológico conocido, y validez de convergencia). Conclusiones. La ECVI-38 es una medida aceptable, fiable y válida para la evaluación de la CV en pacientes que sufrieron un ictus. Se necesitan nuevas pruebas para evaluar su sensibilidad e investigar su utilidad en la práctica clínica e investigadora (AU)

Introduction and aims. Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. Patients and methods. A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. Results. The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach’s α 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). Conclusions. The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice (AU)

[Stroke-specific quality of life scale (ECVI-38): an evaluation of its acceptance, reliability and validity]. / Escala de calidad de vida para el ictus (ECVI-38): evaluación de su aceptabilidad, fiabilidad y validez.

INTRODUCTION AND AIMS: Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. PATIENTS AND METHODS: A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. RESULTS: The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach's alpha 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). CONCLUSIONS: The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice.

[The development of a scale to evaluate the quality of life in stroke survivors]. / Desarrollo de una escala para evaluar la calidad de vida en supervivientes a un ictus.

INTRODUCTION: The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. SUBJECTS AND METHODS: We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following: 1. The percentage of responses left unanswered; 2. A factorial analysis of the main components; 3. Cronbach's alpha coefficient. RESULTS: We interviewed 20 patients and 12 experts; these results were later used to classify the above mentioned aspects in order of priority according to the frequency with which they appeared in the surveys. Then, we elaborated the questionnaire with four areas or subscales by including the questions or items in these categories: I. Physical status (17 items); II. Emotional status (13 items); III. Activities of daily living (13 items); IV. Social and familial functions (13 items). After the pilot study 38 items were reorganised into eight domains, according to the factorial analysis: 1. Physical problems; 2. Communication; 3. Cognition; 4. Emotions; 5. Feelings; 6. Activities of daily living; 7. Familial functions; 8. Social functions. They displayed high coefficients of internal consistency. CONCLUSIONS: We developed a new scale for evaluating the quality of life for stroke patients and it is now ready to undergo its validation process.

Desarrollo de una escala para evaluar la calidad de vida en los supervivientes a un ictus / The development of a scale to evaluate the quality of life in stroke survivors

Introducción. La selección de una medida para evaluar el resultado de las intervenciones terapéuticas en los pacientes con ictus ha tenido un problema conceptual en la necesidad de detectar un amplio intervalo de deficiencias, discapacidades y minusvalías, como parte de un modelo basado en el paciente, y un problema metodológico en la falta de atención sistemática para el desarrollo de instrumentos estándares. Objetivo. Para resolver estas limitaciones realizamos este trabajo, con el objetivo de desarrollar una escala para evaluar la calidad de vida en los supervivientes a un ictus. Sujetos y métodos. Seguimos una metodología estandarizada por otros autores, que se basa en la opinión de los pacientes y los cuidadores para generar los ítems a incluir. Ésta tiene varias etapas, que incluyen: entrevistas individuales a pacientes, cuidadores y expertos, grupos focales con pacientes y expertos, análisis cuantitativo y cualitativo de estas entrevistas, dos paneles de consenso para la confección del instrumento y prueba piloto para reducir y agrupar los ítems en una muestra de 50 pacientes. Para reducir y agrupar los ítems tuvimos en cuenta: 1. El porcentaje de respuestas en blanco; 2.El análisis factorial de componentes principales, y 3. El coeficiente de Cronbach. Resultados. Entrevistamos a 20 pacientes y 12 expertos; con esos resultados, ordenamos los aspectos mencionados en orden de prioridad según la frecuencia de aparición en las encuestas. Posteriormente, confeccionamos el cuestionario con cuatro áreas o subescalas, que incluían las preguntas o ítems en las siguientes categorías: I. Estado físico (17 ítems); II. Estado emocional (13 ítems); III. Actividades de la vida diaria (13 ítems); IV. Funciones sociofamiliares (13 ítems). Después del estudio piloto se reorganizaron 38 ítems en ocho dominios, de acuerdo al análisis factorial: 1.Problemas físicos; 2. Comunicación; 3. Cognición; 4. Emociones; 5. Sentimientos; 6. Actividades de la vida diaria; 7. Funciones familiares; 8. Funciones sociales. Mostraron altos coeficientes de consistencia interna. Conclusión. Se ha desarrollado una nueva escala para evaluar la calidad de vida para el ictus, que se encuentra lista para su proceso de validación (AU)

[Prognosis of cognition in congenital hypothyroidism following early treatment. Double effect hypothesis]. / Pronostico de la cognicion en el hipotiroidismo congenito tratado precozmente. Hipotesis del doble efecto.

INTRODUCTION: The prevention of mental retardation due to congenital hypothyroidism by treating it at an early stage is one of the great achievements of contemporary preventive medicine. Nevertheless, the children suffering from this disease are affected by selective cognitive deficits whose origin remains a controversial issue. PATIENTS AND METHODS: We describe the results from a cohort of 100 children who have been diagnosed as suffering from congenital hypothyroidism in La Havana since 1989 and whose cognitive performance has since been periodically evaluated. The mean age at each evaluation was as follows: 1.1 years (mean and typical deviation: 0.3) and 8.2 years (mean and typical deviation: 1.2). RESULTS: During the first two years of life the developmental quotients are within the normal range of values, although fine oculomotor coordination is significantly diminished. The duration of fetal hypothyroidism is linked to postural control, and the initial biochemical severity of the disease is associated to language development. Oculomotor coordination is not linked to any variable concerning the severity of the disease or with the effectiveness of therapy. At school age, intelligence quotients (IQ) are also within the normal range of values. A multiple regression analysis indicated that the total IQ can be predicted from the scores in oculomotor coordination during the first two years of life and from the initial doses of levothyroxine. CONCLUSIONS: The relations between the variables capable of forecasting intellectual development in these children are analysed and we also discuss the hypothesis which suggests that some of the persisting neurocognitive deficits are probably due to genetic influences that exist regardless of the effectiveness of the therapy.

[Usefulness of P300 as a tool for diagnosing alterations in sustained attention in ischemic cerebrovascular disease]. / Utilidad del P300 como herramienta para el diagnóstico de alteraciones de la atención sostenida en la enfermedad cerebrovascular isquémica.

INTRODUCTION: Event related potentials, and especially the component P300, can be used to achieve greater precision and sensitivity in the cognitive evaluation of patients. They also enable us to obtain more accurate information about deficiencies in sustained attention, which is a cognitive function associated with the generation of the above mentioned component. Furthermore, the study of disorders triggered off by cerebrovascular disease must be given priority because of the high incidence with which they occur. PATIENTS AND METHODS: We studied four groups of individuals divided according to the localization of the lesion and the etiopatogenic mechanism involved (10 patients with right parietal atherothrombotic infarction, 10 patients with left parietal atherothrombotic infarction, 10 patients with lacunar infarction, 10 paired healthy controls). They were administered a classic test for obtaining P300, which evaluates sustained attention. RESULTS: Patients with cerebral infarction in the right hemisphere presented alterations in the functions evaluated, since they showed more omissions, gave fewer correct answers, the values for latency were significantly increased in Fz derivation and amplitude values were reduced in Pz, as compared to healthy controls. Individuals with left cerebral infarction, however, showed no significant differences with regard to the controls. People with lacunar infarction made less mistakes and omissions, and scored more correct answers than those that had suffered right or left infarction. Their amplitude values were also higher than the values of the individuals with a right lesion in Pz derivation but showed no differences as regards the controls. CONCLUSIONS: These results provide new data on the cognitive mechanisms that are affected during a right parietal lesion and demonstrate the sensitivity of P300 in detecting alterations in sustained attention in individuals that differ as regards not only the localization of the lesion but also the type of etiopathogenic mechanism involved.

[Type A behaviour and life events as risk factors for cerebral infarct]. / Patrón de conducta tipo A y acontecimientos vitales como riesgo para el infarto cerebral.

INTRODUCTION: The role of psychosocial factors in cerebral infarct has been little studied and is therefore still undefined. OBJECTIVE and methods. To evaluate the effect of a pattern of behaviour which predisposes to stress, and of life events, on the occurrence of cerebral infarct, we studied a group and control involving 88 patients with cerebral infarcts diagnosed clinically and on imaging studies, and a control group of 99 persons paired for age and sex who lived in our health district. To evaluate the behaviour pattern we used Jenkins abbreviated questionnaire and for life events the Holmes and Rahe questionnaire. RESULTS: The type A behaviour pattern had a highly statistically significant association with cerebral infarct, which was not associated with the effects of other variables. This relation was the greater the lower the age of the person. It was not seen after the age of 75 years. The behaviour pattern was not related to arterial hypertension or with the aetiopathological mechanisms of the patients. In relation to the life events questionnaire, the number of events was significantly associated in the group of patients, but not with the total score of the questionnaire. However, the latter was significantly related to hypertensive patients and persons with a type A behaviour pattern. The commonest life events in both groups were related to the death or health problems of family members, the previous illnesses of the person and to financial and work problems. CONCLUSION: The type A behaviour pattern is individually associated with cerebral infarct, whilst stressful life events were involved in the cerebral infarcts of hypertensive and type A behaviour patients.

Utilidad del P300 como herramienta para el diagnóstico de alteraciones de la atención sostenida en la enfermedad cerebrovascular isquémica / Usefulness of p300 as a tool for diagnosing alterations in sustained attention in ischemic cerebrovascular disease

Introducción. Los potenciales relacionados con eventos, especialmente el componente P300, pueden utilizarse para la evaluación cognitiva de los pacientes con el fin de lograr una mayor precisión y sensibilidad en el examen cognitivo, además de obtener información más precisa sobre las deficiencias en la atención sostenida, función cognitiva relacionada con la generación de dicho componente. El estudio de las afectaciones provocadas por la enfermedad cerebrovascular constituye, por otra parte, una prioridad debido a la alta incidencia de esta patología. Pacientes y métodos. Se estudiaron cuatro grupos de individuos, reunidos según la localización de la lesión y el mecanismo etiopatogénico involucrado (10 pacientes con infarto aterotrombótico parietal derecho, 10 pacientes con infarto aterotrombótico parietal izquierdo, 10 pacientes con infarto lacunar, 10 controles sanos pareados). Se les aplicó un test clásico para la obtención de la P300, que evalúa la atención sostenida. Resultados. Los pacientes con infarto cerebral en el hemisferio derecho presentaron alteraciones en las funciones evaluadas, pues mostraron una mayor cantidad de omisiones, una menor cantidad de respuestas correctas, valores de latencia significativamente aumentados en la derivación Fz y reducidos de la amplitud en Pz que los controles sanos, mientras que los individuos con infarto cerebral izquierdo no mostraron diferencias significativas con respecto a los controles. Las personas con un infarto lacunar cometían menos errores y omisiones y obtenían más respuestas correctas que las que habían sufrido un infarto derecho o izquierdo. Sus valores de amplitud eran igualmente superiores a los valores de los individuos con una lesión derecha en la derivación Pz, sin embargo, no mostraron diferencias en relación con los controles. Conclusiones. Estos resultados proporcionan nuevos datos sobre los mecanismos cognitivos afectados durante una lesión parietal derecha, y muestran la sensibilidad de la P300 para detectar alteraciones de atención sostenida en individuos que difieren no sólo en relación con la localización de la lesión, sino también con el mecanismo etiopatogénico involucrado (AU)

[The quality of life of patients with strokes: from the point of view of factors which may affect it]. / La calidad de vida del paciente con accidente cerebrovascular: una visión desde sus posibles factores determinantes.

OBJECTIVE: To evaluate the effect of clinical and psychosocial factors on the quality of life of patients with stroke. PATIENTS AND METHODS: A non-experimental transverse study was done on 39 patients with strokes seen in the cerebrovascular diseases clinic of the Institute de Neurología y Neurocirugía in La Havana (Cuba). We recorded data on clinical variables (age, sex, race, previous illnesses, type of stroke, vascular territory, classification of prognosis, etiopathogenesis and function on the Rankin scale) and on psychosocial variables (pattern of behavior, anxiety as a feature and state, depression, manner of coping and social support received). Correlations were established with the dependent variable Quality of life, evaluated on the Nottingham Health Profile. RESULTS: Of the clinical variables there was no correlation with age, female sex was related to greater isolation and the presence of diabetes mellitus with less energy. Greater isolation was seen to be correlated with increased score on the Rankin scale, but this association was not statistically significant. Similarly the clinical characteristic of anxiety was related to greater difficulty in sleeping, as also occurred in depression. The latter was also associated with less energy and greater social isolation. The characteristics of self-control, acceptance of responsibility and positive reevaluation had a positive relation with energy and physical mobility. The greater the social support, especially in the area of health, the better the quality of life in the realms of pain, sleep and social isolation. CONCLUSION: The psychosocial aspects had more influence on the quality of life of these patients than the clinical factors did.