Intervenção neuropsicológica com crianças e adolescentes - uma revisão da literatura / Neuropsychological intervention with children and adolescents - a review of the literature / Intervención neuropsicológica con niños y adolescentes - una revisión de la literatura

Este artigo teve como objetivo realizar uma revisão literária sobre os estudos científicos publicados nos últimos dez anos em reabilitação/intervenção neuropsicológica com crianças e adolescentes, buscando identificar como os programas com abordagens voltadas para as dificuldades acadêmicas e executivas se articulam com as demandas familiares e escolares. As principais bases de dados utilizadas foram PubMed, SciELO e Redalyc. Dentre os 89 artigos encontrados, dez foram selecionados por englobarem métodos para o ensino de estratégias que facilitassem a aprendizagem escolar e os comportamentos adaptativos. Os resultados dos estudos sugerem que a intervenção neuropsicológica em crianças e adolescentes promove o desenvolvimento de habilidades cognitivas e dos processos de aquisição de linguagem. Entretanto, em face da distância entre o contexto clínico de intervenção e o educacional, mais estudos precisam ser promovidos em busca de um olhar mais integrado sobre esses espaços de promoção de desenvolvimento.

This article aimed to carry out a literary review of the scientific studies published in the last ten years in neuropsychological rehabilitation/ intervention with children and adolescents, seeking to identify how programs with approaches focused on academic and executive difficulties are articulated with family and school demands . The main databases used were PubMed, SciELO and Redalyc. Among the 89 articles found, ten were selected because they included methods for teaching strategies that facilitated school learning and adaptive behaviors. The results of the studies suggest that neuropsychological intervention in children and adolescents promotes the development of cognitive abilities and the processes of language acquisition. However, in view of the distance between the clinical context of intervention and the educational context, more studies need to be promoted in search of a more integrated view on these spaces for promoting development.

Este artículo tuvo como objetivo realizar una revisión literaria sobre los estudios científicos publicados en los últimos diez años en rehabilitación/ intervención neuropsicológica con niños y adolescentes, buscando identificar cómo los programas con enfoques orientados hacia las dificultades académicas y ejecutivas se articulan con las demandas familiares y escolares. Las principales bases de datos utilizadas fueron PubMed, SciELO y Redalyc. Entre los 89 artículos encontrados, diez fueron seleccionados por englobar métodos para la enseñanza de estrategias que facilitar el aprendizaje escolar y los comportamientos adaptativos. Los resultados de los estudios sugieren que la intervención neuropsicológica en niños y adolescentes promueve el desarrollo de habilidades cognitivas y de los procesos de adquisición de lenguaje. Sin embargo, en vista de la distancia entre el contexto clínico de intervención y el educativo, más estudios necesitan ser promovidos en busca de una mirada más integrada sobre estos espacios de promoción de desarrollo.

Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals / Comparação entre padrões de tromboprofilaxia na artroplastia em hospitais público e privado

Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

Objetivo Comparar a terapia para profilaxia de tromboembolismo venoso e os custos de pacientes submetidos à artroplastia total de joelho e de quadril dentro do sistema de saúde brasileiro.Métodos Estudo retrospectivo com pacientes submetidos à artroplastia no ano de 2010, em um hospital público e dois hospitais privados no Estado de São Paulo, por meio da revisão de prontuários. Os custos foram estimados com base na utilização de recursos em saúde durante a hospitalização. Análise descritiva de frequência e média (desvio padrão), de acordo com o tipo de atendimento em saúde (público ou privado).Resultados Um total de 215 pacientes foram avaliados, sendo 56,3% submetidos à cirurgia de joelho e 43,7% à cirurgia de quadril. Cerca de 88% e 98% dos pacientes provenientes do serviço público e privado de saúde, respectivamente, receberam algum tipo de profilaxia para tromboembolismo, sendo a enoxaparina o medicamento mais utilizado em ambos sistemas. O custo total da profilaxia foi de R$ 1.873,01 (R$ 26,38 por paciente) no serviço público e R$ 21.559,73 (R$ 163,33 por paciente) no serviço privado. Para os indivíduos com tromboembolismo, o custo médio da internação foi de R$ 6.210,80 e R$ 43.792,59 por paciente atendido nos serviços de saúde público e privado, respectivamente.Conclusão A profilaxia em pacientes submetidos à artroplastia é mais utilizada em pacientes do serviço de saúde privado do que público, apesar dos altos custos em ambos os serviços. Os pacientes com tromboembolismo tiveram um custo maior do que aqueles apenas com profilaxia, mostrando que a prevenção está associada a um maior custo-benefício.

Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals.

OBJECTIVE: To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. METHODS: A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). RESULTS: A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. CONCLUSION: Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique.

BACKGROUND/AIM: Hepatic artery anastomosis (HAA) is the most important aspect of living donor liver transplantation (LDLT), and it is currently performed by a specialized microsurgeon using micro surgical techniques, with interrupted sutures and the aid of an operative microscope. To simplify the procedure, we studied a new, simpler technique performed by pediatric transplant surgeons with continuous sutures and the same 3.5× magnification loupe used during other transplant procedures. The aim of this study was to compare these two hepatic artery reconstruction techniques in two pediatric LDLT series. METHODS: This study was initiated in January 2010 and finished in June 2013. In the first period, the arterial reconstruction was performed with an operating microscope and the classical technique of 9-0 separate sutures. In the second period, the arterial reconstruction was performed using a simpler technique, with surgical loupe and continuous 8-0 Prolene sutures. The incidences and outcomes of complications within the two periods were analyzed and compared. RESULTS: A total of 82 LDLTs were performed, 38 in the first period and 44 in the second period. There were no differences between the periods, except for the arterial ischemia time, which was lower in the second period. CONCLUSION: Hepatic artery anastomosis can be safely performed with low complication rates by a pediatric transplant surgeon using continuous sutures with a 3.5× magnifying loupe. This technique is simpler, less time consuming and simplifies the complex pediatric LDLT procedure.

Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders.

OBJECTIVES: To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. METHODS: In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index. RESULTS: The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls. CONCLUSIONS: Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls.

O homem dos ratos, Schreber e Kafka: destinos possíveis para a hostilidade / The rat man, Schreber and Kafka: possible vicissitudes to hostility / El hombre de los ratones, Schreber y Kafka: destinos posibles para la hostilidad

A clínica psicanalítica impõe a observação, por vezes muito presente em determinados quadros, das tendências hostis que aparecem de forma manifesta ou fantasiada. Partindo dessa constatação e sustentado na releitura dos textos freudianos, este trabalho propõe uma reflexão sobre as tendências agressivas e suas implicações na clínica da neurose obsessiva e da paranoia, já que entendemos que a intensidade da hostilidade nessas patologias se coloca, muitas vezes, como um impasse para o tratamento. Os quadros clínicos serão exemplificados por meio do caso do Homem dos Ratos e da história de Schreber. Posteriormente, passaremos a discutir dois textos de Kafka, a fim de indicar uma saída para a elaboração da hostilidade no sentido de simbolizar e de sublimar as tendências agressivas.(AU)

The psychoanalytical practice demands the observation of acted or fantasized hostile tendencies which are very common in certain cases. We believe that the intensity of hostility has an increase in cases like obsessive neurosis and paranoia and often become an impediment to treatment. Considering such matters and based on Freud's texts, this paper proposes a reflection on the aggressive tendencies and their implications in the treatment of obsessive neurosis and paranoia. The clinical frames will be exemplified by The Rat Man and the history of Schreber. Subsequently we will discuss two texts of Kafka, to indicate an answer to the elaboration of hostility towards symbolization and sublimation of the aggressive tendencies.(AU)

La clínica psicoanalítica impone la observación, algunas veces muy presente en determinados cuadros, de las tendencias hostiles que aparecen de forma manifiesta o fantaseada. Partiendo de esa constatación y sostenido en la relectura de los textos freudianos, este trabajo propone una reflexión sobre las inclinaciones agresivas y sus implicaciones en la clínica de la neurosis obsesiva y de la paranoia, ya que entendemos que la intensidad de la hostilidad en esas patologías se coloca, muchas veces, como un impasse para el tratamiento. Los cuadros clínicos serán ejemplarizados por medio del caso del Hombre de los Ratones y de la historia de Schreber. Posteriormente, pasaremos a discutir dos textos de Kafka, con el fin de indicar una salida para la elaboración de la hostilidad en el sentido de simbolizar y de sublimar las inclinaciones agresivas.(AU)

O homem dos ratos, Schreber e Kafka: destinos possíveis para a hostilidade / The rat man, Schreber and Kafka: possible vicissitudes to hostility / El hombre de los ratones, Schreber y Kafka: destinos posibles para la hostilidad

A clínica psicanalítica impõe a observação, por vezes muito presente em determinados quadros, das tendências hostis que aparecem de forma manifesta ou fantasiada. Partindo dessa constatação e sustentado na releitura dos textos freudianos, este trabalho propõe uma reflexão sobre as tendências agressivas e suas implicações na clínica da neurose obsessiva e da paranoia, já que entendemos que a intensidade da hostilidade nessas patologias se coloca, muitas vezes, como um impasse para o tratamento. Os quadros clínicos serão exemplificados por meio do caso do Homem dos Ratos e da história de Schreber. Posteriormente, passaremos a discutir dois textos de Kafka, a fim de indicar uma saída para a elaboração da hostilidade no sentido de simbolizar e de sublimar as tendências agressivas...

The psychoanalytical practice demands the observation of acted or fantasized hostile tendencies which are very common in certain cases. We believe that the intensity of hostility has an increase in cases like obsessive neurosis and paranoia and often become an impediment to treatment. Considering such matters and based on Freud's texts, this paper proposes a reflection on the aggressive tendencies and their implications in the treatment of obsessive neurosis and paranoia. The clinical frames will be exemplified by The Rat Man and the history of Schreber. Subsequently we will discuss two texts of Kafka, to indicate an answer to the elaboration of hostility towards symbolization and sublimation of the aggressive tendencies...

La clínica psicoanalítica impone la observación, algunas veces muy presente en determinados cuadros, de las tendencias hostiles que aparecen de forma manifiesta o fantaseada. Partiendo de esa constatación y sostenido en la relectura de los textos freudianos, este trabajo propone una reflexión sobre las inclinaciones agresivas y sus implicaciones en la clínica de la neurosis obsesiva y de la paranoia, ya que entendemos que la intensidad de la hostilidad en esas patologías se coloca, muchas veces, como un impasse para el tratamiento. Los cuadros clínicos serán ejemplarizados por medio del caso del Hombre de los Ratones y de la historia de Schreber. Posteriormente, pasaremos a discutir dos textos de Kafka, con el fin de indicar una salida para la elaboración de la hostilidad en el sentido de simbolizar y de sublimar las inclinaciones agresivas...

Presença de aditivos conservantes (nitrito e sulfito) em carnes bovinas moídas, comercializadas em mercados varejistas / Presence of additive conserving (nitrite and sulphite) in grounded beef, commercialized in the retail markets

No presente trabalho, objetivou-se avaliar a prática fraudulenta da adição de nitrito e sulfito, e parâmetros físico-químicos de qualidade em carnes bovinas moídas in natura e resfriadas, comercializadas em mercados varejistas do estado do Rio de Janeiro. Avaliou-se também o grau de depleção do nitrito pós-cocção. Os resultados obtidos demonstraram que de 35 amostras analisadas, 37,14% apresentaram nitrito, 11,42% sulfito, 17,14% amônia e 17,14% odor desagradável na prova da cocção. Todas as amostras apresentaram o valor de pH dentro do padrão oficial. A maior concentração de nitrito detectada foi 1,17mg.Kg-1 e a menor 0,173 mg.Kg-1. Após cozimento de amostras onde se detectou nitrito, houve depleção significativa desta substância. A detecção de nitrito e sulfito em carnes in natura além de caracterizar o descumprimento da legislação vigente por parte dos comerciantes, pode representar um risco à saúde da população, devido ao potencial tóxico destas substâncias quando ingeridas em excesso.

So, the present work aims to evaluate the quality physiochemical parameters as well as the nitrite and sulphite fraudulent addition to “in natura” grounded beef which was cooled commercialized in the State of Rio retail markets. The nitrite depletion degree after cooking was also evaluated. Our results have demonstrated that in 35 analyzed samples, 37.14% presented sodium nitrite while 11.42% sulphite, 17.14% ammonia and 17.14% unpleasant smell at cooking test. All the samples presented standard pH value. 1.17 mg.Kg-1 and 0.173 mg.Kg-1 were the highest and the lowest nitrite concentration detected, respectively. We found significant depletion of the nitrite after cookihg the samples with this substance. The detention of nitrite and sulfite in meats “in natura” characterizes the disobedience of the current law. The addition of these substances can represent a risk to the health of the population. They are potentially toxic substances when ingested in excess.

Análise de custo do tratamento medicamentoso da artrite reumatóide / Cost analysis of drug therapy in rheumatoid arthritis

Com o objetivo de comparar custos de tratamento para artrite reumatóide com medicamentos modificadores do curso da doença (DMARDs) por um período de 48 meses, foram estudadas cinco diferentes etapas de tratamento fundamentadas em protocolos clínicos recomendados pela Sociedade Brasileira de Reumatologia com cinco ciclos de tratamento. Foi aplicado modelo analítico de decisão baseado na Análise de Markov, considerando as probabilidades do permanecer em algumas destas etapas ou transitar entre elas de acordo com a resposta à terapia. Foram usados os custos diretos com medicamentos, matérias médico-hospitalares para sua administração e exames laboratoriais necessários para o monitoramento do paciente. O modelo revelou que o ciclo que representa o uso do metotrexato em monoterapia foi o mais custo/efetivo (R$ 113.900,00 por paciente em 48 meses), seguido pelo paciente refratário (R$ 1.554.483,43), aquele que utiliza a tripla terapia e depois o biológico (R$ 1.701.286,76), o paciente intolerante ao metotrexato (R$ 2.629.919,14), e por fim o resultado daquele que iniciaria o tratamento já com o infliximabe mais metotrexato (R$ 9.292.879,31). A análise de sensibilidade demonstrou que os resultados encontrados são robustos, mesmo com a variação da eficácia do metrotrexate e do infliximabe.

With the aim to compare the cost of treatment for rheumatoid arthritis therapy with desease-modifying antirheumatic drugs (DMARDs) for a 48-month period, were studied five different treatment stage based on clinical protocols recommended by the Brazilian Society of Rheumatology, and then five therapy cycles. The analytical model based on the Markov Analysis, considered chaces for the patient continue in some stages or change between them according with a positive effect on outcomes. Only direct costs were comprised in the analyzed data, like drugs, materials and tests used for monitoring these patients. The results of the model show that the stage in with metotrexato drug is used like monotherapy was cost-effective (R$ 113,900.00 for patient during 48 months), followed by refractory patient (R$ 1,554,483.43), those that use therapy triplicate followed by infleximabe drug (R$ 1,701,286.76), the metotrexato intolerant patient (R$ 2,629,919.14), and final the result from that use metotrexato and infliximabe in the beginning (R$ 9,292,879.31). The sensitivity analysis confirm this results, when alternate the efficacy of metotrexato and infliximabe.