Continuing education in the child health handbook: an educational software for primary care1

ObjectiveTo present, the process of development and evaluation of an educational software on the Child Health Handbook proposed for the continuing education of primary care nurses and physicians.MethodsQuantitative study of methodological development. For software development, the following steps were followed: definition of objectives; determination of the target audience; choice of pedagogical and theoretical reference for content; content selection and structuring; software development and evaluation by experts (five nurses and four physicians). All responded to an instrument that included four domains: pedagogical; content; functionality; system presentation and usability. The evaluation criteria were arranged on a Likert-type scale. The percentage of agreement and Content Validity Index were used for the quantitative analysis of the degree of agreement, considering a Content Validity Index cutoff point equal to 0.80.ResultsThe overall agreement index, calculated by the arithmetic mean of the Contents Validity Index of the evaluated domains, was 0.96, with scores ranging from 0.90 to 1.00. The average percentage of agreement of the experts per domain was 92.86%, with lower agreement in the content (80.95%), presentation, and usability (90.48%) domains. 100% of percentage of agreement was observed in the pedagogical and functionality domains among the evaluated specialists.ConclusionThe percentage of agreement, Content Validity Index and overall agreement index of the Child Health Handbook educational software in the context of primary care disclosed the software adequacy as an educational resource for continuing education of primary care nurses and physicians. Considering the assessed dimensions, it can also be used by other health professionals and undergraduate students.     

Temporal lobe epilepsy with varying severity: MRI study of 222 patients

MRI was performed in 222 consecutive adult patients with temporal lobe epilepsy of varying severity from January 1991 to May 1993. The diagnosis of hippocampal sclerosis was established visually by three independent observers. The accuracy of visual assessment of hippocampal asymmetry was compared with volumetric measurements. Neuropathological correlations were obtained in 63 patients with refractory seizures. Temporal lobe abnormalities were observed in 180 patients (81 %) as follows: hippocampal sclerosis in 122 (55 %); developmental abnormalities in 16 (7.2 %); tumours in 15 (6.8 %); scars in 11 (5 %); cavernous angiomas in 10 (4.5 %); miscellaneous lesions in 6. MRI was normal or showed unrelated changes in 42 patients (19 %). Visual assessment correctly lateralised hippocampal sclerosis in 79 of the 84 patients measured (94 %). Temporal lobectomy confirmed the MRI data (side and aetiology) in all 63 operated patients. Patients with normal MRI had an older age of seizure onset and were more often drug-responsive than patients with hippocampal sclerosis. MRI showed temporal lobe abnormalities in 81 % of epileptic patients with varying severity with good neuropathological correlation. Patients with normal MRI had a less severe form of the disease. Received: 19 August 1996 Accepted: 13 November 1996     

Severe algodystrophy of the foot simulating ischemic arteriopathy. Spectacular cure by regional sympathetic block with guanethidine

The authors report a case of severe algodystrophy of the foot complicating a typical episode of algodystrophy of the knee, and which resulted in appearances of acute ischaemia of the foot. Paraclinical investigations seemed to support this aetiology but arteriography excluded this diagnosis, showing only regular distal arterial narrowing. This case illustrates the extremely variable clinical and paraclinical features of algodystrophy and the possibility of significant hypofixation from the onset and during the course of algodystrophy in young patients. It shows that there are no specific, constant clinical signs or paraclinical changes. From the therapeutic point of view, it confirms the often spectacular effects of prolonged regional sympathetic nerve block with Guanethidine which may give an immediate and definitive cure of severe algodystrophy when all else has failed.     

Extrinsic compression of the renal artery by diaphragmatic crus

Extrinsic compression of the renal artery due to a fibromuscular band originating from the diaphragm was encountered in a 26-year-old patient who had systemic hypertension associated with stenosis and kinking of one of her renal arteries. After surgical decompression, the renal artery assumed a normal expansion with disappearance of hypertension. Six other cases of extrinsic compression of the renal artery have been found in the literature. Surgical treatment is mandatory in all cases because the mechanism that causes the lesion makes percutaneous transluminal angioplasty illusory.     

Risk factors for asthma in adolescents in a large urban region of Brazil.

BACKGROUND: Identify risk factors for asthma in adolescents from S?o Paulo, Brazil. METHODS: total of 528 adolescents (141 asthmatics, 387 control subjects) from the ISAAC study (phase III) were submitted to a complementary questionnaire to evaluate risk factors, through response to questions regarding personal history, environment, and diet and an agreement to undergo the skin prick test (SPT) for aeroallergens. RESULTS: Positive SPT to at least one allergen occurred in 49.4% adolescents. The risk factors for asthma were: prematurity (OR: 3.84, 95% CI: 1.54-9.64), rhinitis (OR: 3.18, 95% CI: 1.71-5.91), positivity in the SPT (OR: 2.81, 95% CI: 1.48-5.32), eczema in characteristic skin-folds (OR: 2.86, 95% CI: 1.13-7.26), and an allergic mother (OR: 2.01, 95% CI: 1.02-3.93). The consumption of cooked vegetables was a protective factor for asthma (OR: 0.37, 95% CI: 0.18-0.79) CONCLUSIONS: Asthma is a multifatorial disease. An allergic mother, aeroallergen sensitization, rhinitis, eczema and prematurity were considered risk factors and the consumption of cooked vegetables was considered a protective factor for asthma in this population.     

Scolioses idiopathiques et congénitales

Résumé D'étiologie toujours inconnue, la scoliose idiopathique de l'adolescent ne peut être traitée efficacement que si le dépistage est très précoce, entre 8 et 10 ans. La preuve de l'évolutivité angulaire doit être faite avant d'entreprendre un traitement orthopédique, dont l'objectif sera de contrôler l'aggravation liée à la poussée de croissance pubertaire. De nouveaux protocoles à temps partiel sont actuellement à l'étude et s'adresseront à des courbures peu sévères et bien réductibles. Les indications opératoires sont posées en cas d'échec ou d'intolérance au traitement orthopédique. Les limites angulaires pour de telles interventions semblent diminuer progressivement, les techniques devenant plus fiables. On accorde par ailleurs de plus en plus d'importance au plan sagittal, compte tenu de la mauvaise tolérance à long terme des lordoses thoraciques. Malgré les progrès techniques, la réalisation d'une arthrodèse solide avec une greffe abondante reste le seul garant de la stabilité angulaire. L'évolution et l'histoire naturelle des courbures congénitales du rachis sont actuellement bien connues, ainsi que les malformations viscérales habituellement associées. La surveillance radiographique dès le plus jeune âge permet d'évaluer l'asymétrie de croissance vertébrale dans le plan frontal et sagittal. Ceci permet de proposer en cas d'évolutivité un traitement à visée étiologique précoce, sous forme d'une hémi arthrodèse et épiphysiodèse convexe, antérieure et postérieure pour freiner l'hypercroissance du côté de la malformation. Pour les formes dépistées plus tardivement, une greffe postérieure avec ou sans matériel est l'indication classique, en évitant absolument toute manoeuvre de distraction qui comporte un risque de complication neurologique, en particulier en cas de composante cyphotique associée.

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Idiopathic and congenital scoliosis

Summary The exact etiology of idiopathic scoliosis is still unknown and therefore the only way to improve the prognosis is to recommend an early screening program, between 8 and 10 years of age. Angular progression must be proven for every curve before any brace application. The goal of such a treatment is to control curve progression during the adolescent growth spur. Recent part-time bracing programs have been proposed for low angle and flexible curves. Surgery is indicated in case of failure or non compliance of the conservative treatment. Currently the angular limits for surgery seem to decrease, as a result of improved surgical techniques. Sagittal unbalance and loss of thoracic lordosis are of major importance for the treatment choice, since their poor outcome in the adult population. Despite technical improvements, the quality of a solid fusion is the most important factor for long lasting results. The natural history and evolution of congenital spine deformities have been precisely documented, as well as the frequently associated visceral problems. Repeated curve measurements in young children will evaluate the growth potential asymetry in the coronal and sagittal planes. In case of rapidly progressive curves, an early surgical treatment can be proposed, consisting in convex anterior and posterior hemiarthrodesis, producing an epiphysiodesis effect of the overgrowing convex side. For cases diagnosed in older ages, the classic indication is a posterior fusion, with or without instrumentation. It is important to avoid any excessive distraction, because of a high risk of neurological complications, especially in case of an associated kyphotic deformity.

Travail présenté aux Actualités. en Orthopédie Pédiatrique organisées par le Dr Cl. Karger, le 19 au 21 mars 1992 à Aubure