Validação por expertos de uma proposta metodológica para promoção de atitudes positivas perante a deficiência em ambientes inclusivos / Validación por expertos de una propuesta metodológica para promover actitudes positivas hacia la discapacidad en entornos inclusivos / Validation by experts of a methodological proposal to promote positive attitudes towards disability in inclusive environments

A Actividade Física Adaptada à Pessoa com Deficiência (PcD) é reconhecida como um óptimo meio para a inclusão social desse grupo. No entanto, o grau de inclusão da PcD dependerá em grande parte das atitudes manifestadas pelos diferentes grupos populacionais, assumindo que uma atitude positiva influencia o comportamento da pessoa em relação a um grupo social específico. Em Moçambique, espera-se que técnicos desportivos capacitados em modalidades adaptadas à PcD, além de técnicos, sejam agentes que promovam a inclusão social. OBJECTIVO: o objectivo do presente estudo foi validar uma proposta metodológica que gere atitudes positivas em relação à deficiência, melhorando assim o perfil dos formados em cursos de agentes desportivos. MÉTODO: a proposta foi submetida a um processo de validação por especialistas, composto por um painel de 21 especialistas de quatro países (Espanha, Portugal, Brasil e Moçambique), seleccionados por meio de um questionário para determinação do coeficiente de competência. Para a análise dos resultados, foi utilizada a estatística inferencial (medidas de tendência central e dispersão) e o coeficiente de concordância "W de Kendall". RESULTADO: os especialistas avaliaram satisfatoriamente oito descritores, dentre eles, o contexto da proposta e sua aplicabilidade; o desenho, objectivos e estratégias da metodologia; os critérios de sucesso, o tempo estimado para sua implementação e os resultados esperados. CONCLUSÃO: foi validada por especialistas uma proposta metodológica com o objectivo de melhorar a atitude do formando em relação à deficiência

La Actividad Física Adaptada a la persona con discapacidad (PcD) es reconocida como un óptimo medio para la inclusión social de este grupo. Sin embardo, el grado de inclusión de las PcD dependerá en gran medida de las actitudes manifestadas por los diferentes grupos de población, asumiéndose que una actitud positiva influye en el comportamiento de la persona hacia un grupo social específico. En Mozambique, se espera que los técnicos deportivos formados en modalidades adaptadas a la PcD, sean además de técnicos, agentes dinamizadores de la inclusión social. OBJETIVO: el objetivo del presente estudio fue validar una propuesta metodológica que origine actitudes positivas hacia la discapacidad, mejorando así el perfil de salida de los formandos en cursos de técnicos deportivos. MÉTODO: la propuesta fue sometida a un proceso de validación por expertos, compuesto por un panel de 21 especialistas de cuatro países (España, Portugal, Brasil y Mozambique), seleccionados a través de un cuestionario para determinar el coeficiente de competencia. Para el análisis de los resultados se recurrió a la estadística inferencial (medidas de tendencia central y de dispersión) y el coeficiente de concordancia "W de Kendall". RESULTADO: los expertos evaluaron satisfactoriamente ocho descriptores, entre ellos, el contexto de la propuesta y su aplicabilidad; el diseño, objetivos y estrategias de la metodología; los criterios de éxito, el tiempo estimado para su implementación y los resultados esperados. CONCLUSIÓN: quedó validada por especialistas una propuesta metodológica con objetivo de mejorar la actitud del formando hacia la discapacidad

The Physical Activity Adapted to the Person with Disabilities (PwD) is recognized as an optimal path for the social inclusion of this group. However, the degree of inclusion of PwD will largely depend on the attitudes manifested by the different population groups, assuming that a positive attitude influences the behavior of the person towards a specific social group. In Mozambique, it is expected that the sports technicians trained in modalities adapted to the PwD, in addition to being technicians, will be agents that stimulate social inclusion. OBJECTIVE: the objective of the present study was to validate a methodological proposal that generates positive attitudes towards disability, thus improving the profile of the trainees leaving in courses for sports technicians. METHOD: the proposal was submitted to a validation process by experts, made up of a panel of 21 specialists from four countries (Spain, Portugal, Brazil and Mozambique), selected through a questionnaire to determine the coefficient of competence. For the analysis of the results, inferential statistics (measures of central tendency and dispersion) and the coefficient of agreement "Kendall's W" were used. RESULT: the experts satisfactorily evaluated eight descriptors, among them, the context of the proposal and its applicability; the design, objectives and strategies of the methodology; the success criteria, the estimated time for its implementation and the expected results. CONCLUSION: a methodological proposal with the aim of improving the attitude of the person being trained towards disability was validated by specialists

[Urgent management of obstructing colo-rectal cancer: authors' experience]. / Trattamento in urgenza delle occlusioni intestinali da cancro del colon-retto: nostra esperienza.

PURPOSE: The aim of this retrospective study is to compare the different surgical approaches in obstructing colo-rectal cancer in terms of mortality, morbidity and quality of life. MATERIALS AND METHODS: We observed 379 patients with colorectal cancer, 354 of which underwent surgical treatment, 189 M (53.4%) and 165 F (46.6%), with a median age of 72.6 years. Complicated tumors were 150 (42.4%), with 126 obstructions (84%). For 95 obstructing left-sided colorectal cancers we performed: 9 defunctioning colostomies; 62 two-stages operations: 55 Hartmann's procedures, 5 primary anastomosis with colostomy; 2 primary anastomosis with on table wash-out and ileostomy; 24 single-stage operations: 17 primary anastomosis with on table wash-out and 7 colectomy. RESULTS: The overall operative mortality rate was 8.7% (11/126). The overall leak rate was 8% (5/62), 12.9% (4/31) in left colon and 3.2% (1/31) in right colon, all treated conservatively. The wound infection rate was 23.8% (30/126). DISCUSSION AND CONCLUSIONS: Obstructing colo-rectal cancer is associated with a high operative mortality and a worse prognosis. Defunctioning colostomy can be regarded as a valid option only in extreme circumstances. Hartmann's operation has indicated in case of metastatic disease, unsure anastomosis, simultaneous colonic perforation. The gold-standard is primary anastomosis, as colonic resection with on table wash-out or subtotal/total colectomy, in case of largely distended colon or synchronous lesions.

[Conservative treatment of a large retroperitoneal hematoma following extracorporeal shock wave lithotripsy (ESWL): case report and literature review]. / Trattamento conservativo di voluminoso ematoma retroperitoneale (ERP) secondario a litotripsia renale ad onde d'urto (ESWL): case report e revisione della letteratura.

Retroperitoneal and subcapsular renal hematomas, following extracorporeal shock wave lithotripsy (ESWL) occur rarely, but the large number of this treatment performed has to be considered. The knowledge of risk factors, natural history and complications represents a crucial factor in the correct management of these lesions, that generally must be treated conservatively, monitoring clinical parameters and eco-TC diameters of the hematoma. Surgical approache is indicated only in case of haemodinamic instability not responsive to medical therapy and, after 1-2 months, to try to improve renal disfunction due to compression. In this paper we present a case of retroperitoneal hematoma after ESWL and review the literature, so as to define the management of these lesions.

[Abdominal lymphoma with abscess and thoracic perforation: en-bloc resection]. / Linfoma addominale ascessualizzato e perforato in torace: resezione "en-bloc".

The authors compare a rare case of acute onset Gastric Lymphoma with that present in the literature. The patient, a white 67 year-old man, was admitted to hospital in severe general condition. On CT scan an opacity of the pleura and a subtotal collapse of the left lung associated with a mass infiltrating the diaphragm, the gastric fundus and pancreas were seen. After 48 hours from the admission an operation was performed. The abdominal mass infiltrating the stomach, the spleen and the left thorax was resected en-bloc by laparotomy. A Boulau drainage was inserted. The histology showed an high malignant, diffused, big cell lymphoma. The patient was discharged 23 days later after a regular postoperative course. Surgery can be necessary, sometime curative in gastric lymphomas while long term result and quality of life could be improved by chemotherapy.

[Primary anastomosis in the neoplastic colonic obstruction]. / L'anastomosi primaria nell'occlusione colica neoplastica.

The authors report their own experience on the treatment of large bowel obstruction caused by a neoplastic stenosis. During a 36-month period 110 operations for emergency large bowel obstructions were performed: 59 (53.6%) underwent primary anastomosis without colostomy (28 right colectomy, 16 left colectomy, 9 sub-total and 6 total colectomy). Total group post-operative mortality was 2.9% as a result of cardio-pulmonary complications. Morbidity was 19.8%, included a 3% of anastomotic leak underwent surgical treatment. Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in a high proportion of cases of emergency large bowel obstructions.

[Acute cholecystitis: timing of surgery]. / Le colecistiti acute: timing of surgery.

The authors report their own experience about 156 cases of acute cholecystitis observed between January 1991 and October 1992. The most part of the patients were between 30 and 65 years old (84 cases observed). In 27 cases, for the positive evolution of the pathology, it was put on practice a non operative treatment. The other 129 cases were treated surgically. The patients with lithiasic cholecystitis were 148; those affected by non lithiasic cholecystitis were 5; and 3 of them presented an acute cholecystitis as a manifestation of a carcinoma. Between the various diagnostic methods, the echography, executed in emergency, is considered as an indispensable one, for having changed completely the diagnostic approach. It is discussed, particularly, the timing of surgery, an aspect able to influence considerably the therapeutic iter and its results. There are analysed the criteria for whom some authors are favourable to a medical treatment of the acute cholecystitis, postponing the operation, while other of them are favourable to an early surgical treatment. The authors' casuistry put in evidence 110 operations effectuated in emergency (< 12 hours), 19 operations after an 12-72 hours interval, no operations at a long distance (1-10 months). The results are to be considered satisfactory: 1 deceased (on 129 operated cases, 0.78%); 10 immediate complications (7.75%): 8 suppurations of the wound, 1 biliar fistula and 1 internal hemorrhage after video-laparoscopic operation; 2 late complications (1.55%): they were relapsing gallstones. The aim of this work is to offer a contribution to codification of the treatment of the acute cholecystitis, on the ground of the acquired experience.

[Giant benign and malignant pathology of the ovary]. / Patologia gigante benigna e maligna dell'ovaio.

After a discussion of ovarian tumour classification, two cases of giant neoplasm, one benign the other malignant are reported. Ultrasonography and CA125 research represent two irreplaceable investigations, for preoperative balance and for therapeutic strategy.