ESTUDIO CLINICO DE JELLINEK PDF

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Evaluation of the Pediatric Symptom Checklist as a screening tool for the identification of emotional and psychosocial problems. Sandra Regina B. Muzzolon 1. Cat 2. To investigate the Brazilian version of Pediatric Symptom Checklist PSC as a screening tool to identify psychosocial and emotional problems in schoolchildren from six to 12 years old.

The results of the two instruments were compared. Among the cases, 49 The ROC curve showed the PSC score of 21 as the best cutoff point for screening psychosocial and emotional problems, with a sensitivity of De los padres invitados a participar del estudio, contestaron a la LSP y al CBCL, constituyendo la muestra, y los resultados de los dos instrumentos fueron comparados. The identification of psychosocial and emotional problems should be part of pediatric practice.

Studies have documented the increased prevalence of mental disorders MD in children and adolescents. The recognition, intervention, and preventive care of mental disorders in children and adolescents help define and reduce the effects on personality, not yet fully formed, contributing to a healthy development. The relationship between genetic and environmental factors in the origin of MDs is dynamic and cumulative in its capacity to influence development and change their future conditions.

The negative result of situations experienced in childhood, the genetic, biologic, psychological, and environmental risk factors, as well as the complex interactions between them, can lead to the appearance of one or more MDs. These inter-relations may hinder diagnosis and, consequently, an early intervention by health professionals who are not familiar with these clinical features.

However, the indicative of a mental disorder in childhood and adolescence should not be confused with the normal characteristics of developmental stages, which may present similar pathological symptoms. The present study evaluated the accuracy of the Brazilian version of the PSC - Pediatric Symptom Checklist - as a screening instrument for emotional and psychosocial problems in a population of schoolchildren aged from 6 to 12 years, comparing the results with those obtained by the CBCL.

It is a questionnaire with 35 items, with a fast fill-in process, which reflects the impression of parents on the behavior and development of the child. The CBCL, in turn, is a questionnaire also responded by parents, that assesses emotional and behavior problems, being considered a standard instrument in child and adolescent psychology. A total of agreed to participate and responded to the first assessment instrument, the PSC, reporting the results to the participants.

These parents were asked to respond to a second assessment instrument, the CBCL. Among these, agreed, constituting, thus, the study sample. The results of the administration of the two instruments in this sample were compared, considering the gold standard set by the CBCL. It consists of 35 items, valid for the age group from 6 to 16 years.

It is easy to administer, to understand, and to interpret the results. The score attributed by the respondent, who indicates how often the situation proposed in the question occurs, is zero for "never" one for "sometimes" and two for "often". It is a comprehensive instrument considered as gold standard, answered by the parents. It reports the skills and problems in children or adolescents between 6 and 18 years and provides an analysis of the emotional, social, and behavioral profile of the individual, divided in two parts.

The first refers to the Social Competence, i. The second part refers to the assessment of the existence of emotional and behavioral problems. The sum of the scores is converted into T-scores, according to appropriate analyzes for age and gender. In this case, it is presented in scale and syndromes, that is, problems that usually occur together. Parents or guardians signed an informed consent form. When studying in detail the 62 children Among these, 29 presented externalizing and internalizing problems; 17, only externalizing; 13, only internalizing; and three, other problems.

Borderline cases were excluded from this analysis Table 2. Considering the frequencies obtained, the result of the PSC showed a sensitivity of This difference was due to the breaking rules syndrome and aggressive behavior, more common in males.

In the ROC curve, considering as a dependent variable the total clinical versus normal problems, and as an independent variable, the score of the PSC, it was obtained 21 as the cutoff score, with sensitivity of The area under the curve was 0.

In developed countries, one in ten children presents at least one MD. Similarly, in a retrospective study on antisocial behavior in adolescence 11 , it was noted that adolescents with problems already presented psychological signs at years old, demonstrating, thus, that characteristic symptoms of internalizing and externalizing problems may be often predictive 12 , An increase in referrals to mental health professionals was effective in reducing and improving symptoms as well as in the score of the PSC in a second reassessment Among the who did not agree in answering the CBCL, only nine 3.

The frequency observed in this study is similar to that of the U. In a Hispanic population 16 living in the state of Texas, there was a similar prevalence, of The results of the PSC which indicate the degree of reliability and validity in relation to the CBCL, used in this study as the gold-standard, are very similar to those found in studies conducted in other countries 2 , 15 - The questions chosen to compose the PSC reflect emotional and behavioral characteristics that are important for the identification of these problems in schoolchildren By observing the frequency of responses to the grouping of questions , 10, 11, 13, 15, 19, , 27 and 30; Chart 1 , the pediatricians should consider, in their assessment, characteristics of internalizing problems, i.

Questions 12, 16, 17, 25, 26, 29, 31, Chart 1 are characteristic of externalizing problems, such as aggression and rule breaking. Not following the rules is a behavior that is part of the development of children, especially from years of age and in adolescence. However, when this kind of behavior occurs often, consistently, and with damages to adaptive functioning, it may indicate oppositional defiant disorder. Both in the participants that responded only to the PSC and the who responded to both instruments, it was observed a predominance of positivity in the male gender.

The results of the PSC showed good internal consistency and reliability of measurement. Considering the outcome of risk of emotional and psychosocial problems established by the CBCL, the ROC curve showed that the cutoff for this population was 21 points, with a sensitivity of When observing how the curve would behave with the cutoff point proposed for the U.

This reveals that the Brazilian sample behaves similarly to the U. In a study in the Netherlands 2 , a cutoff of 22 points was proposed, with sensibility of High cutoffs select a smaller number of people, probably covering the most affected, which, in fact, require specialized evaluation.

Lower cutoffs select a larger number of subjects, and among them, those with little or no real problems, creating a great demand for specialized assessments and perhaps unnecessary concern for the family. Thus, the identification of children and adolescents with MDs cannot be restricted to a single assessment instrument and to numeric accuracy.

One should not oversimplify this complex task. The role of the pediatrician is essential, both in clinical assessment and in the assessment of the results of the screening instrument, in this case, the PSC.

This assessment may help the professional to decide for the orientation of the family and the next reassessment or, if not sure or capable, he may refer the family to an appointment with a specialist. Between 21 and 27 points, there are cases in which the clinical evaluation is crucial to decide for the referral or close observation by the pediatrician.

It is the role of the pediatrician, a professional who has a great bond with families, to know how to recognize the different MDs for early interventions. The increasing emphasis on productivity and profitability adds more pressure on this professional, further limiting attention to the emotional and psychosocial problems. The use of screening tools for MDs as part of routine health care of children and adolescents may facilitate recognition and early referral, as well as information on the clinical symptoms of physical and organic origin.

The PSC is a screening test for children and adolescents aged from zero to 16 years, of easy administration, understanding, and interpretation, besides the great degree of respect, reliability, and validity in relation to the CBCL gold standard. The pediatrician who already uses other screening tools will find it easy to handle it. Parents can answer the questions while they wait for the pediatric consultation of their children. The second is up to the pediatrician, together with parents, so that a final decision regarding the referral is made.

Factor analysis of the Pediatric Symptom Checklist with a chronically ill pediatric population. J Dev Behav Pediatr ; Use of the Pediatric Sympton Checklist for the detection of psychosocial problems in preventive child healthcare. BMC Public Health ; Soc Psychiatry Psychiatr Epidemiol ; Arch Gen Psychiatry ; Achenbach TM.

Burlington: University of Vermont; Altman DG. Practical statistics for medical research. Brief psychosocial screening in outpatient pediatric practice. J Pediatr ; Pediatrics ; Mental health service use among young children receiving pediatric primary care. Moffitt TE, Caspi A. Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females.

Dev Psychopathol ; Diagnosis and treatment of behavioral health disorders in pediatric practice. Mesman J, Koot HM. Estimates of the prevalence of child maladjustment in a community survey in Puerto Rico.

The use of combined measures. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med ; Screening Mexicans for psychosocial and behavioral problems during pediatric consultation. Rev Invest Clin ; Thun-Hohenstein L, Herzog S. The predictive value of the pediatric symptom checklist in 5-year-old Austrian children.

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ESTUDIO CLINICO DE JELLINEK PDF

A randomised controlled trial on the efficacy of a multidisciplinary health care team on morbidity and mortality of elderly patients attending the Emergency Department. Study design and preliminary results. Hospital Manacor. Hospital de Jerez. Objective: To estimate the prevalence of potentially Inadequate drug prescriptions In elderly patients who attend the Emergency Department.

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Mektilar Paciencia con el Ignorante. Claridad sobre lo que se pretende. Twenty-two subjects available in this category. Estragos en cuerpos mortales y en congregaciones. Efucaz images slides in preparation. Aram Reports on the clinico -pathology and mechanisms of trypanosomosis in free-living and captive wild animals showed that clinical disease and outbreaks occur more commonly among captive than free-living wild animals. Jellinek worked laboriously to learn more about alcoholism, addiction and estudioo health.

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