Search

BackgroundThis cross-sectional study explores the connections between burnout, personal resources, and teaching motivation among Italian special needs teachers (SNTs) one year following the start of the COVID-19 pandemic. It specifically seeks to determine if and how personal resources and teaching motivation can help SNTs by buffering the effects of burnout symptoms.MethodsThe study was conducted using a sample of 837 full-time, in-service kindergarten and primary teachers at public schools in Italy. Data were collected through self-report questionnaires, including the Copenhagen Burnout Inventory, the Santa Clara Brief Compassion Scale, the Crèche Educators Emotional Style Questionnaire, and the Autonomous Motivations for Teaching Scale. A multiple regression model was performed to assess the predictive role of personal resources and teaching motivation on the burnout of special needs teachers.ResultsThe findings indicate that higher levels of autonomous motivation are associated with reduced burnout, specifically among special education teachers. Conversely, higher levels of negative emotion regulation strategies were linked to increased burnout, and this relationship was stronger in mainstream teachers than in special education teachers. We found no significant association between teachers’ compassion and burnout.ConclusionsOur research supports the need for educational policymakers and school leaders to focus on personal resources and work-related well-being to enhance and support teachers, in particular during emergencies (e.g., the COVID-19 pandemic) and for specific groups of teachers, such as SNTs.

Background/Objectives: Children with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) exhibit more executive function (EF) deficits compared to typically developing (TD) peers. EF deficits are linked to various impairments in daily functioning and increased parental stress. The first aim of the present study is to investigate EFs in children with ASD and ADHD compared to their TD peers. The second aim is to explore profiles of executive functions in children with ASD and ADHD and, finally, to determine the differences of EF profiles in relation to parental stress and children’s functional impairments. Methods: The sample comprised 30 TD children, 47 children with ASD, and 34 children with ADHD, aged 8 to 12 years. Parents completed questionnaires of parenting stress, and children’s social and daily-life functioning. Parents and teachers reported information about children’s EF. Results: The results indicated significantly greater impairment of EFs in the clinical groups compared to the TD group. Moreover, three distinct clusters of functioning were identified based on the severity of reported EF difficulties. The significant findings showed that children with more severe EF profiles were associated with greater daily impairment and higher levels of perceived parental stress. Conclusions: Given the impact of EF deficits on the lives of children with ASD and ADHD and their families, it is crucial that studies like this enhance our understanding and inspire future interventions aimed at improving executive functions in children with ASD and ADHD. Such interventions could help reduce parental stress and improve daily functioning.

Introduction: The topic of blood pressure in children and adolescents has taken a marked interest in the last years, due to the increment of its prevalence in this population group Objective: To evaluate the prescription of medications in children and adolescents with hypertension assisted in Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital in Santiago de Cuba. Methods: An observational, descriptive and cross-sectional investigation that squared with a medications use study, of indication-prescription type, therapeutic outlines and practical consequences, of 39 patients with diagnosis of hypertension assisted in the Cardiology Service of the hospital abovementioned, was carried out from January to December, 2018, who fulfilled the established selection approaches. Main variables (prescription and adverse reactions) and control variables (age, skin colour, sex and risk factors) were used. Results: There was a prevalence of the male sex (79.4 %), 15-18 age group (66.6% ), primary hypertension (stage 1), black skin patients and obesity as the risk factor mostly identified (58.9 %). Conclusions: The prescriptions were evaluated in their majority as appropriate, what demonstrates the preventive approach and the rational use of medications.

Abstract Background Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors. Methods Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses). Results The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals. Conclusions The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.

The purpose of this study is to extend the knowledge about academic achievement in individuals with autism spectrum disorder (ASD). To this end, first, we analyzed differences in a wide range of reading and writing skills in adolescents with ASD without intellectual disability (ASD-WID) and adolescents with typical development (TD). Second, these two groups were compared on academic outcomes in core subjects and indicators of successful transition to secondary school. Third, the potential contribution of literacy skills to academic outcomes was examined in the two groups. Participants were 56 adolescents between 12 and 14 years old, 30 with ASD-WID and 26 with TD. Results showed no significant differences between the two groups on measures of reading fluency or literal and inferential comprehension. However, the performance of the group with ASD was significantly lower on reading comprehension processes that assess cognitive flexibility. Regarding their written expression skills, significant differences were observed between the group with ASD and the group with TD on most of the indicators analyzed as: productivity, lexical diversity, and overall coherence (resolution component). In addition, findings showed that the deficits in reading and writing observed in the adolescents with ASD significantly affected their academic achievement, which was lower than that of their peers with TD and below what would be expected based on their intellectual capacity. Moreover, their families’ perceptions of the transition to high school reflected worse adjustment and lower self-esteem, confidence, and motivation.

Introduction. Deficits in inhibition, emotional control, working memory and monitoring have been evidenced in numerous investigations focused on attention déficit hyperactivity disorder (ADHD), but information about its posible differential influence on the characteristic manifestations of the disorder is not very well known. Objectives.The purpose of this study was to analyze the relationships and the predictive power of the regulation functions (inhibition and emotional control) and metacognitive functions (working memory and supervisión) in the manifestations of ADHD. Method. Sixty-one Young adults between the ages of 18 and 24 with a combined clinical diagnosis of ADHD subtype in childhood completed the Conners Scale of ADHD Symptoms and the Executive Performance Inventory (BRIEF). Results. Statistically significant relationships were found between inhibition, emotional regulation, working memory and monitoring and the Conners subscales. In addittion, deficits in executive functions were diferentially sensitive in predicting significant ADHD problems. Working memory and supervisión were predictors of attention problems, inhibition prediced self-concept problems and hyperactivity/restlessness while emotional self-control was the best predictor of impulsivity. Conclusions. The assessment of behavioral regulation functions and metacognitive executive functions may assist both in the diagnosis and the follow-up evaluations of treatment of adults with ADHD.

Introduction. Literature shows that families of children with attention deficit hyperactivity disorder (ADHD) experience risk factors related to high levels of stress, less social support, or less coping skills. These contextual family factors can be aggravated by the presence of behavioral and social problems in children with ADHD. Aims. The present study set out the following objectives: 1) To identify profiles of families of children with ADHD at school age according to contextual indicators and socio-emotional variables such as stress level, coping strategies and social support. 2) To evaluate the differences between groups established in different domains of behavioral and emotional difficulties. Method. Thirty-five children, between 7 and 11 years old, who had received a clinical diagnosis of ADHD participated in this study. A family risk index was determined from the information provided by the families on the educational level, professional situation, parental psychopathology and parental status. In addition, the level of parental stress, social support, coping skills and behavioral and emotional problems of the child were evaluated. Results. Hierarchical cluster analyses carried out determined the existence of two groups of families; one with “severe risk” and another one with “moderate-low risk”. The severe profile was associated with greater social problems in children. Specifically, more hyperactivity and problems with peers. Conclusions. Contextual and socio-emotional factors of families should be taken into account in the approach of behavioral problems that children with ADHD present.

Theory of Mind (ToM) is one of the most relevant concepts in the field of social cognition, particularly in the case of Autism Spectrum Disorders (ASD). Literature showing that individuals with ASD display deficits in ToM is extensive and robust. However, some related issues deserve more research: the heterogeneous profile of ToM abilities in children with ASD and the association between different levels of ToM development and social, pragmatic, and adaptive behaviors in everyday life. The first objective of this study was to identify profiles of children with ASD without intellectual disability (ID), based on explicit and applied ToM knowledge, and compare these profiles with a group of children with typical development (TD). A second objective was to determine differences in symptom severity, adaptive/social behavior, and pragmatic abilities between the profiles identified. Fifty-two children with a clinical diagnosis of ASD without ID and 37 children with TD performed neuropsychological ToM tasks and two vocabulary and memory tests. In addition, all of their mothers completed different questionnaires about applied ToM abilities, severity of ASD symptoms, adaptive/social skills, and pragmatic competence. Two subgroups were identified in the cluster analysis carried out with explicit and applied ToM indicators. The “Lower ToM abilities” profile obtained significantly lower scores than the “Higher ToM abilities” profile on all the ToM measures. Furthermore, the analysis of covariance, controlling for vocabulary and working memory (ANCOVAs), showed statistically significant differences in applied ToM abilities between the two groups of children with ASD without ID and the group with TD. However, only the group with “Higher ToM abilities” achieved similar performance to the TD group on the verbal task of explicit ToM knowledge. Finally, the “Lower ToM abilities” cluster obtained significantly higher scores on autism symptoms (social and communication domains) and lower scores on adaptive behavior and pragmatic skills than the cluster with “Higher ToM abilities.” Taken together, these findings have implications for understanding the heterogeneity in ToM skills in children with ASD without ID, and their differential impact on social, communicative, and adaptive behaviors.

Introduction. Children with autism spectrum disorder (ASD) present more difficulties in adaptive functioning than children with typical development, probably due to the symptoms of the disorder. However, recent studies suggest a multifactorial implication in adaptive deficits, although more research is needed to identify the most important factors. Aims. 1) Examine the differences in the adaptive functioning profile of children with ASD and children with typical development (TD); 2) Study in children with ASD the relationship between adaptive skills and the nuclear symptomatology of autism along with behavioral and emotional problems. Method. Participants were 87 children (52 with a diagnosis of high functioning ASD and 36 with typical development) between 7 and 11 years matched in age and cognitive ability. The Vineland-II scale and the Strengths and Difficulties questionnaire (SDQ) were completed. In addition, the dimensional scores of criteria A and B of the DSM- 5 were used to assess the symptomatology of ASD. Results. Significant differences were observed between both groups in all vineland domains. Regression analyzes revealed that socio-communicative difficulties had a greater impact on the adaptive functioning of children with ASD, although behavioral problems also explained dysfunctions in the Vineland social skills sub-domain. Conclusions. Our findings indicate that socio-communicative deficits have greater predictive power to explain adaptive difficulties than repetitive and stereotyped behavior patterns in children with high-functioning ASD.

The literature has explored the learning problems presented by children with autism spectrum disorder (ASD), but the impact of comorbidity with attention deficit hyperactivity disorder (ADHD) on learning in children with ASD has barely been analyzed. Goals. 1) To analyze the differences in the learning behavior of children with ASD with and without comorbidity with ADHD and children with typical development (TD); 2) Investigate the association between different domains of learning behaviors and behavioral and emotional problems in children with ASD and children with ASD + ADHD. Method. 87 children participated (30 with a diagnosis of high functioning ASD, 22 with ASD + ADHD and 36 with TD between 7 and 11 years matched in age, cognitive ability and vocabulary.) Teachers reported on the scale of learning behaviors (LBS), and the parents completed the Strengths and Difficulties questionnaire (SDQ) Results The results showed significant differences between children with ASD with and without comorbidity in all LBS domains, and correlations revealed that less flexibility in the search of strategies for greater emotional problems in ASD and greater behavioral problems in ASD + ADHD Conclusions The findings highlight the negative impact of ADHD symptoms on all the learning prerequisites analyzed. emotional and behavioral problems in the ability to change when planning learning strategies in children with autism high performance.

The present study investigated the mediating role of behavioral difficulties, coping strategies, and social functional support in the relationship between symptoms severity and parenting stress in mothers of children with ASD (autism spectrum disorder). The parenting stress questionnaire, coping orientation to problems experienced scale, strengths and difficulties questionnaire, and Duke-UNC social support questionnaire were administered to 52 mothers, who also estimated the ASD severity symptoms of their children. Correlation analyses revealed that parenting stress was positively correlated with the children’s ASD symptoms and behavioral problems. On the other hand, parenting stress was negatively correlated with the engagement coping and social functional support reported by the mothers. Multiple mediation analysis indicated that engagement coping and behavioral difficulties were significant mediators in the relationship between ASD symptoms and parenting stress, with the engagement variable having a larger effect. The findings illustrate the need to promote the mothers’ engagement coping orientation and the application of behavioral strategies with their children to help them to buffer the impact of stress.

Objetivos. Comparar el perfil de niños con trastorno del espectro autista (TEA) y niños con trastorno por déficit de atención con hiperactividad (TDAH), presentación combinada, en componentes del funcionamiento ejecutivo (FE) y en comportamientos que están asociados al aprendizaje. Método. Participaron en esta investigación 16 niños con un diagnóstico clínico de TDAH y 16 niños con un diagnóstico clínico de TEA con alto nivel de funcionamiento que habían sido diagnosticados en servicios de Neuropediatría de la Comunidad Valenciana. Las edades estaban comprendidas entre 7 y 11 años. El 94% eran varones y se encontraban escolarizados en aulas ordinarias, estando equiparados los dos grupos en edad y capacidad intelectual. Los profesores cumplimentaron el Inventario de funcionamiento ejecutivo (Behavior Rating Inventory of Executive Function; BRIEF; Gioia et al., 2000) que valora un espectro amplio de funciones ejecutivas y la escala de conductas de aprendizaje (Learning Behaviours Scale-LBS; McDermott et al., 2001) que aporta información sobre motivación, actitud hacia el aprendizaje, atención/persistencia y flexibilidad/estrategias de aprendizaje. Resultados. Los niños con TDAH presentaron significativamente más dificultades que los niños con TEA en memoria de trabajo y en planificación. Además, aunque ambos grupos experimentaron problemas que superan lo esperado, también los niños con TDAH estuvieron más afectados en los índices generales de FE, el índice metacognitivo y el de regulación comportamental. En la misma línea, en las conductas de aprendizaje, tampoco aparecieron diferencias significativas entre TEA y TDAH, si bien el porcentaje de casos afectados se situó en un nivel claramente superior en niños con TDAH a excepción del factor de flexibilidad/estrategia de aprendizaje. Conclusiones. Se comentan las implicaciones de los hallazgos para optimizar los procedimientos de enseñanza de niños con TEA y con TDAH.

Los jóvenes con trastorno por déficit de atención con hiperactividad (TDAH) tienen un elevado riesgo de uso de sustancias (US). Los objetivos del presente trabajo fueron: 1) analizar el consumo de alcohol, tabaco, marihuana y otras drogas ilegales en adultos con y sin TDAH; 2) comparar a los adultos con TDAH con y sin US en oposicionismo, problemas de conducta, ansiedad, depresión, sueno˜ y personalidad antisocial; 3) determinar la capacidad de la sintomatología de TDAH y de los problemas de conducta para predecir el US. Noventa y tres jóvenes adultos, 43 sin TDAH y 50 con diagnóstico de TDAH en la infancia que participaron en el estudio Multicenter ADHD Genetics (IMAGE) colaboraron en una evaluación de seguimiento 10.1 anos ˜ después. Los participantes con TDAH se dividieron en dos subgrupos según presencia o ausencia de US. Los jóvenes con y sin TDAH se diferenciaron significativamente en consumo de tabaco, marihuana y alcohol. Se constató una relación significativa entre los trastornos de conducta y US en adultos TDAH. Los problemas de conducta más que los síntomas de TDAH influyen en el US de adultos con TDAH.

In spite of its importance for education, the relationship between learning behaviors (LB), attention deficit hyperactivity disorder symptoms (ADHD) and executive functioning (EF) in children with autism spectrum disorder (ASD) has hardly been explored. The first objective of the present study was to compare children with ASD without intellectual disability and children with typical development (TD) on ADHD symptoms and learning behaviors: Motivation/competence, attitude toward learning, persistence on the task, and strategy/flexibility. The second objective was to analyze the mediator role of behavioral regulation and metacognition components of EF between ADHD symptoms and learning behaviors in children with ASD. Participants were 89 children between 7 and 11 years old, 52 with ASD and 37 with TD, matched on age and intelligence. Their teachers filled out questionnaires assessing executive functioning as well as learning behaviors. Parents and teachers reported on inattention and hyperactivity/impulsivity behaviors. Compared to children with TD, children with ASD presented significantly more ADHD symptoms and poorer learning behaviors. In addition, there were significant mediation effects of the behavioral regulation index (BRI) and metacognition index (MI) of EF, indicating that both are part of the route through which ADHD symptoms impact to learning behaviors of children with ASD.

Antecedentes y objetivos. Pocos estudios han analizado la contribución del funcionamiento ejecutivo (FE) a la calidad de vida (CAV) en sujetos con TDAH. Objetivos del trabajo: (1) Explorar las diferencias entre adultos con y sin TDAH en calidad de vida (2) Comparar la calidad de vida entre adultos TDAH con y sin dificultades en funcionamiento ejecutivo (3) Analizar la influencia de los problemas en Funciones ejecutivasven la calidad de vida de adultos con TDAH. Métodología. 36 jóvenes con TDAH y 27 sin el trastorno cumplimentaron cuestionarios sobre calidad de vida y funcionamiento ejecutivo Resultados. Se hallaron diferencias estadísticamente significativas entre jóvenes TDAH con y sin deterioro en funcionamiento ejecutivo en áreas de calidad de vida. En particular los problemas en la metacognición se asociaron con una menor percepción de calidad de vida. Conclusiones. La identificación de los factores que influyen en la calidad vida puede ayudar a la aplicación de programas de tratamiento más efectivos.

Introducción. Los niños con TDAH tienden a sobreestimar su funcionamiento social, conductual y académico, un asunto que ha sido poco investigado en adultos con TDAH. Objetivos. Los objetivos de este trabajo son: 1) Examinar el perfil de funcionamiento ejecutivo de adultos jóvenes con TDAH; 2) Estudiar la relación entre las habilidades de funcionamiento ejecutivo percibidas por adultos con TDAH y sus padres; 3) Comparar las puntuaciones diferenciales (entre las versiones de observador y autoinforme) de adultos con TDAH y adultos con desarrollo típico. Método. Participaron 93 adultos (50 con un diagnóstico de TDAH en la infancia y 43 con desarrollo típico) entre 17 y 24 años. Se aplicaron las versiones de autoinforme y del observador del Behavior Rating Inventory of Executive Function–versión para adultos (BRIEF-A) para la evaluación de funcionamiento ejecutivo. Se calcularon puntuaciones diferenciales para cada una de las subescalas restando las puntuaciones T estimadas por los padres menos las puntuaciones T estimadas por los jóvenes con TDAH. Resultados. Los adultos con TDAH sobreestimaron las habilidades de funcionamiento ejecutivo en comparación con sus padres. Las versiones del BRIEF-autoinforme y BRIEF-observador correlacionaron significativamente en los dominios de regulación comportamental. Las puntuaciones diferenciales fueron estadísticamente superiores en el grupo con TDAH que en el grupo control. Conclusiones. Los adultos jóvenes con TDAH sobreestiman sus habilidades de funcionamiento ejecutivo en comparación con sus padres lo cual subraya la necesidad de contar con la colaboración de otras personas familiares con los pacientes en la evaluación.

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children's ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention.

El presente trabajo aborda dos objetivos: a) analizar las diferencias en el estrés de los padres de niños y adolescentes con TDAH con altas y bajas puntuaciones en factores de éxito relacionados con la resiliencia b) estudiar la relación entre estos factores de éxito y el nivel de satisfacción con la vida del niño en distintos dominios. Para ello, 46 familias cumplimentaron los cuestionarios de Evaluación de Atributos de Éxito, el dominio del padre del Parenting Stress Index y las Escalas de Satisfacción Vital. Los resultados indican diferencias estadísticamente significativas en el estrés de los padres de niños con TDAH y puntuaciones altas y bajas en autoconciencia, proactividad, perseverancia y establecimiento de metas. La satisfacción vital se asoció a los atributos de éxito. Se comentan las implicaciones para la investigación y para la práctica clínica de estos hallazgos.

Se realizó un estudio descriptivo, longitudinal y prospectivo del síndrome de inmunodeficiencia humana en niños institucionalizados en el Hospital Nacional de Mpilo en Zimbabwe desde abril de 2005 hasta marzo de 2006. La casuística estuvo constituida por todos los niños hasta 12 años, atendidos en la Clínica de Infecciones Oportunistas perteneciente a este centro hospitalario y donde previamente se les diagnosticó la afección durante su ingreso. Se analizaron las variables: edad, sexo, vías de contagio, estadios clínicos, enfermedades asociadas más frecuentes y principales causas de muerte. Se halló que el grupo más afectado tenía entre 18 meses a 4 años, con mayor incidencia en el sexo femenino; que predominaron los niños en estadios III y IV del síndrome, así como también que se asociaron preponderantemente al proceso infeccioso: la candidiasis bucal, las neumonías bacterianas y las diarreas persistentes. Entre las principales causas de muerte figuraron las neumonías por Neummocisti carinii en lactantes menores de 18 meses y las bacterianas en los niños mayores de esa edad.A descriptive, longitudinal and prospective study of the human immunodeficiency syndrome was carried out in children institutionalized in Mpilo National Hospital in Zimbabwe from April, 2005 to March, 2006. The case material was formed by all the children up to 12 years, attended in the Opportunistic Infections Clinic belonging to this hospital and where they were previously diagnosed with the disease during their admissions. Variables such as age, sex, route of infection, clinical stages, more frequent associated diseases and main causes of death were analyzed. It was found that the most affected group was between 18 months and 4 years, with a higher incidence in the female; that children in stages III and IV of the syndrome prevailed, as well as that they were predominantly associated with the infectious process: oral candidiasis, bacterial pneumonias and persistent diarrheas. Among the main causes of death were pneumonias by Neumocistis carinii in infants under 18 months and bacterial pneumonias in children over that age.

Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of MediSur is the property of Centro Provincial de Informacion de Ciencias Medicas de Cinfuegos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of MEDISAN is the property of Centro Provincial de Informacion en Ciencias Medicas de Santiago de Cuba and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)