BackgroundThere are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation.MethodsK-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients.ResultsA total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders.ConclusionsThe factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1773-0) contains supplementary material, which is available to authorized users.

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Vincular las fuentes de estrés, el afrontamiento y el desempeño académico en los estudiantes de medicina.Para ésto se llevó a cabo un estudio longitudinal en el que participaron 93 estudiantes en eL primer año y 80 estudiantes de segundo año en el seguimiento, pertenecientes a un programa de alto desempeño académico de la carrera de medicina. Se aplicó el Cuestionario de Fuentes de Estrés en Estudiantes de Medicina y el Cuestionario de Estrategias de Afrontamiento en cuatro momentos (al inicio y al final del primero y segundo años). Se observó que el nivel de estrés se mantuvo sin cambios significativos para primero y segundo años, tanto en la primera como segunda evaluación (F=2.18,p=0.09). Sin embargo, sólo el puntaje de estrés detectado en la primera medición del primer año se relacionó de forma significativa con el promedio final de este año escolar (r=-0.33, p≤0.05). El afrontamiento predominante en ambos años de la carrera de medicina fue la estrategia de “Solución de problemas” y la menos utilizada fue el “Distanciamiento”. Al comparar las estrategias de afrontamiento entre los estudiantes de primero y segundo años, se observaron diferencias en el uso del “distanciamiento”,que fue más utilizado por los alumnos en segundo año y el “apoyo social” por los alumnos en primero. A pesar de que las calificaciones fueron menores en los estudiantes cuya estrategia de afrontamiento predominante fue el “pensamiento mágico” y los niveles de estrés más altos, no hubo diferencias significativas con respecto a las otras estrategias. Se concluyó, que los niveles de estrés permanecen constantes en los alumnos de primero y segundo años de la carrera de medicina, pero las fuentes que lo generan y el modo de afrontarlas, se modifican conforme transcurre el ciclo escolar y parecen asociarse al desempeño académico de esta población.

Introduction. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of the world population, with symptoms that may persist into adulthood. Despite the findings on the clinical course of this disorder, information regarding comorbidity patterns, psychosocial and executive functioning in adult life in those with and without ADHD in Latin American samples is scarce. Objective. The aim of this study is to compare the comorbidity pattern, psychosocial, and executive functioning of adults with and without ADHD from a clinical sample. Method. One hundred and fifty-one patients between 20 and 45 years, with screened positively on ASRS-V1.1, were invited to continue an evaluation process as part of clinical research program (PROMETEO): 1) K-SADS-PL Mx interview, 2) MINI-Plus interview, ASRS-V1-1 18 item version, BRIEF self-reported questionnaire, SCQA-ADHD, and 3) Individual case review by clinical expert in ADHD. Results. Individuals in the ADHD group had a higher average of comorbid disorders (2.5 SD 1.1 vs. 1.3 SD 1.0 respectively, F = .439; t = -6.621; df = 149; p < .001), more likelihood of procrastinating (OR = 6.5; 95% CI[2.6, 16.2]; z = 4.0) and were more likely to present difficulties in both the behavior regulation index (OR = 104.9; 95% CI[31.8, 345.7]; z = 7.65) and the metacognitive index (OR = 94.79; 95% CI[29.10, 308.76]; z = 7.56) compared to the non-ADHD group, regardless of gender. Discussion and conclusions. Our results indicate that the ADHD adult group presented with more comorbidity, and worse psychosocial and executive functioning than non-ADHD adults.

Background Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO 2 was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO 2 levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

A web-based image classification tool (DiLearn) was developed to facilitate active learning in the oral health profession. Students engage with oral lesion images using swipe gestures to classify each image into pre-determined categories (e.g., left for refer and right for no intervention). To assemble the training modules and to provide feedback to students, DiLearn requires each oral lesion image to be classified, with various features displayed in the image. The collection of accurate meta-information is a crucial step for enabling the self-directed active learning approach taken in DiLearn. The purpose of this study is to evaluate the classification consistency of features in oral lesion images by experts and students for use in the learning tool. Twenty oral lesion images from DiLearn’s image bank were classified by three oral lesion experts and two senior dental hygiene students using the same rubric containing eight features. Classification agreement among and between raters were evaluated using Fleiss’ and Cohen’s Kappa. Classification agreement among the three experts ranged from identical (Fleiss’ Kappa = 1) for “clinical action”, to slight agreement for “border regularity” (Fleiss’ Kappa = 0.136), with the majority of categories having fair to moderate agreement (Fleiss’ Kappa = 0.332–0.545). Inclusion of the two student raters with the experts yielded fair to moderate overall classification agreement (Fleiss’ Kappa = 0.224–0.554), with the exception of “morphology”. The feature of clinical action could be accurately classified, while other anatomical features indirectly related to diagnosis had a lower classification consistency. The findings suggest that one oral lesion expert or two student raters can provide fairly consistent meta-information for selected categories of features implicated in the creation of image classification tasks in DiLearn.