A função mediadora do planejamento na aula de leitura de textos literários

This dissertation sutdies the mediative function in the planning of literary text reading classes of Portuguese. Its main central focus proposes that planning favors the pedagogical reading work of literary texts in the teaching of Portuguese, for they are regarded as one of the mediative elements the teaching-learning process. It also allows for its subjects to rethink the practice, theorizing it. As a theoretical basis the studies on participative planning are used, especially the studies concerning dialogic planning. The language/literature teaching perspective adopted in this work is guided by the socio-interactive conception of language, in a way that reading is seen as a comprehensive and interactive activity. Given the research process, the analysis of the reading process involved the Reader s Response, once that this theory considers the role of the reader and her/his interaction with the text. The study is grounded upon the following research question: which role(s) does the pedagogical planning play as a mediator of the reading teaching-learning process? The main objective of this dissertation is to investigate the pedagogical planning activity as a mediative instrument in the practice of reading in the Portuguese classes. The study is constituted of three stages, the third being emphasized (2002/2005) in which the direction of the participative action-research was used, as a way of acknowledging the pedagogical role in the teaching plan, as an instrument capable of rendering reorganization in the teaching-learning process of reading classes. We have as participants teachers of Portuguese in the elementary school (Ensino Fundamental, 3º ciclo), besides other segments of public schools, in the city of Pau dos Ferros RN, in which the previous studies were developed. The results point to the relevance in the role of the teacher, as a more experienced reader, in developing of pedagogical strategies that may come to favor the teaching of reading, having in the pedagogical sphere an instrument of theoretical reflection and sistematization of activities to be implemented in the classroom. The conclusions highlight the class plan as the mediative instrument to be incorporated and internalized into the teaching practice, amplifying and modifying the teacher s intervention forms, favoring, thus, her/his pedagogical mediation

Vivência de mulheres no puerpério : significado atribuído à revisão pósparto

The consultation for women during the postpartum period should occur between the seventh and tenth days, and 42 days after childbirth, to decrease the incidence of maternal and neonatal morbidity and mortality. However, the effectiveness of such assistance in primary health care has not been achieved, especially in the forty-second day of puerperium. Facing this reality, the research aimed to understand the views of women about postpartum consultation. This is an exploratory and descriptive research with qualitative approach, developed in the municipality of Lajes/RN, Brazil, with women inscribed on the four teams that make up the Family Health Strategy. Data were collected through semistructured interviews with 15 women who met the following criteria: be enrolled in ESF; have health mental preserved, have been entered in the Humanization Program of Prenatal and Birth, and that was, at maximum, 60 days postpartum. The data were organized according to the precepts of content analysis according to Bardin, generating three categories: prevention of puerperal complications, feelings related to life changes after childbirth, and postpartum care. This process of coding and categorizing a central theme emerged: the experience of women in the postpartum period. The data were analyzed according to the principles of symbolic interactionism, according to Blumer. The study revealed that the meanings attributed to the postpartum period for prevention of complications were directly related to home, to the consultation and postpartum care provided by family members and health professionals. The interviewees strictly complied with the rest under the influence of the context in which they were entered. But that has not happened with the postpartum revision because few mothers underwent this procedure. Therefore, the interaction of the interviewed people in their living standard as well as the feelings that permeated the post-partum were crucial to consider whether or not the post-partum visit as significant. According to the results, it was noted that disability guidelines and counter-references has impaired the access of women to postpartum review. Thus, further studies are needed on the subject, as well as a reorientation of health care activities in view of the consolidation of postpartum consultation in primary care

Avaliação dos textos informativos em três embalagens de café

O presente trabalho tem o objetivo de apresentar uma investigação sobre o nível de clareza dos textos informativos dos rótulos de embalagens de café torrado e moído, considerando os aspectos lingüísticos e ergonômicos presentes nos rótulos do produto. Lingüisticamente analisar se a linguagem utilizada nos rótulos é adequada para a compreensão das informações pelo consumidor, ainda expor como a lingüística preconiza a organização e estruturação dos textos a partir da classificação do gênero textual. Do ponto de vista da ergonomia a pesquisa pretende identificar a conformidade ergonômica presente nas informações dos rótulos das embalagens de café. Devido à evolução das atividades comerciais, a embalagem passou ao longo do tempo a acumular funções, transformando-se em um considerável veículo de comunicação, informação e sedução do seu público consumidor, por isso, a adoção de normas adequadas relativas às informações pode evitar que o consumidor desenvolva conceitos inadequados ou até mesmo empregue erroneamente um produto alimentício em sua dieta. A engenharia de produção considera importante a inserção de melhores práticas de produção e gestão do produto nas empresas, com vistas ao aumento de sua competitividade, compatibilizando as características ergonômicas do produto embalagem, com as necessidades do consumidor enquanto parte integrante do processo de desenvolvimento do produto. A pesquisa propõe, então, um roteiro para avaliação dos rótulos de embalagens, utilizando para isso um questionário com questões fechadas e uma aberta, aplicados em consumidores de café torrado e moído no momento da compra em quatro supermercados de Natal. Os principais resultados da investigação demonstram que os aspectos lingüísticos dos textos informativos foram considerados bons, enquanto os aspectos ergonômicos informacionais analisados podem vir a contribuir para uma melhoria visual das informações contidas nos rótulos das embalagens das marcas de café investigadas

A modalização como estratégia argumentativa em textos de vestibulandos

In this work, the argumentative strategies construction in university entrance examinations texts is analyzed. The study intended to present, through the analyzed occurrences in the corpus, the discursive strategies use for the argumentation construction, observing the different lexicalization forms and the effects that these strategies produced for the intended meaning construction. Aiming to analyze the modalization via texts written by candidates for the UFRN entrance examination, the relations between this category and the resources used for the argumentative guidance of the text were highlighted. Conceived as a speaker argumentative strategy to express his/her relationship with the proposition content which enunciates, the modalization is, thus, one of the linguistic expression form used for the attainment of intended meaning effects in the argumentation construction. In order to substantiate the research, the theoretical assumptions adopted were the propositions which deal with this linguistic category, guiding it to a pragmatic-semantic perspective as well as a discursive-semantic one. Hence, Neves ( 1996, 2006), Koch ( 2000, 2002), Cervoni ( 1989), Bronkart (1999) and Castilho; Morais de Castilho (1996) studies, among others founded this work. Afterwards, a contextualized analysis of the modalized statements, taking into account all the set of elements implied on the argumentation construction, was carried out. The research, which had a strict qualitative character, revealed that the candidates make use of modalization to express commitment or dissociation as regards the statement which they produce; to obtain credibility and provide more authority to their arguments, thus avoiding them of being contested; to impose their arguments as real ones and acquire acceptance of the interlocutor; to lessen the proposition content and disguise the knowledge source; to comment the enunciation and attribute the discourse to another sender; to establish a dialogic relation with the interlocutor. In addition to offering support for new investigations, the research also aims to contribute for the mother tongue teaching, emphasizing the need of a focus which provides special attention to the written language functioning and its application diversity. In this work, the argumentative strategies construction in university entrance examinations texts is analyzed. The study intended to present, through the analyzed occurrences in the corpus, the discursive strategies use for the argumentation construction, observing the different lexicalization forms and the effects that these strategies produced for the intended meaning construction. Aiming to analyze the modalization via texts written by candidates for the UFRN entrance examination, the relations between this category and the resources used for the argumentative guidance of the text were highlighted. Conceived as a speaker argumentative strategy to express his/her relationship with the proposition content which enunciates, the modalization is, thus, one of the linguistic expression form used for the attainment of intended meaning effects in the argumentation construction. In order to substantiate the research, the theoretical assumptions adopted were the propositions which deal with this linguistic category, guiding it to a pragmatic-semantic perspective as well as a discursive-semantic one. Hence, Neves ( 1996, 2006), Koch ( 2000, 2002), Cervoni ( 1989), Bronkart (1999) and Castilho; Morais de Castilho (1996) studies, among others founded this work. Afterwards, a contextualized analysis of the modalized statements, taking into account all the set of elements implied on the argumentation construction, was carried out. The research, which had a strict qualitative character, revealed that the candidates make use of modalization to express commitment or dissociation as regards the statement which they produce; to obtain credibility and provide more authority to their arguments, thus avoiding them of being contested; to impose their arguments as real ones and acquire acceptance of the interlocutor; to lessen the proposition content and disguise the knowledge source; to comment the enunciation and attribute the discourse to another sender; to establish a dialogic relation with the interlocutor. In addition to offering support for new investigations, the research also aims to contribute for the mother tongue teaching, emphasizing the need of a focus which provides special attention to the written language functioning and its application diversity

O leitor universitário e a construção das práticas de ler e escrever textos impressos e digitais

The construction of a mapping of the practices of reading and writing printed and digital texts, declared by graduating students from the Bachelor s degree in Science and Technology (BCT), has provided us the analysis of the course they are making in such a socio-historical moment characterized by the revolution of the post-paper. In this sense, the general objective of this research is to understand how that construction works under the point of view of those graduating students. For this, our reflection has been guided by the search of answers for some questions which have presented to us: what reading and writing conceptions BCT graduating students have; what reading and writing practices those collaborators develop; what collections they declare to have access to; what differences they declare to have between printed and digital reading and writing along the different social roles they develop; what the reader/writer identity relations of those collaborators are. To achieving the plausible answers, we have gathered a corpus composed by texts of three genres of the argument order: academic profiles (or self-portrait), opinion articles and argumentative letters. Besides, we have made semi-structured interviews and questionnaires in the online tool of the Google Docs. The methodology which supports this academic work is the qualitative research (SIGNORINI; CAVALCANTI, 1998)of ethnographic direction (THOMAS, 1993; ANDRÉ, 1995) in Applied Linguistics (CELANI, 2000; MOITA-LOPES, 2006) and the theoretical contribution comes from the bakhtinian perspective of language conception (BAKHTIN [1929] 1981); the socio-historical writing construction (LÉVY, 1996; CHARTIER, R., 1998, 2002, 2007; COSCARELLI, 2006; CHARTIER, A., 2007; ARAÚJO, 2007; COSCARELLI; RIBEIRO, 2007; XAVIER, 2009; MARCUSCHI; XAVIER, 2010); from the studies of the pedagogy of the writing (GIROUX, 1997); from the literacy studies understood as sociocultural practice, plural and situated (TFOUNI, 1988; KLEIMAN, 1995; TINOCO, 2003, 2008; OLIVEIRA; KLEIMAN, 2008), from the studies about identity in postmodernity (HALL, 2003; BAUMAN, 2005). The results of the analysis have pointed at a multiplicity of reading/writing practices of printed and digital texts developed by the BCT graduating students due to the coexistence of the modality printed and that one derived from the new mobile devices. In that multiplicity, the prevalent idea of the collaborators is that there is a continuum between printed texts and digital texts (not a dichotomy), since the option of reading/writing printed texts or digital ones is always linked to specific communication situations, which involve participants, objectives, strategies, values, (dis)advantages, besides (re)creation of discursive genres in function of the mobile devices to which those collaborators have access in the different spheres of activities that they participate. All of that has caused a deep intersection in the identity traces of college students readers/writers in the 21st century which cannot be ignored by academic formation

Processos cognitivos que operam na configuração de narrativas: uma pesquisa exploratória dos fenômenos que subjazem à compreensão de textos

This paper investigates the cognitive processes that operate in understanding narratives in this case, the novel Macunaíma, by Mário de Andrade. Our work belongs to the field of Embodied-based Cognitive Linguistics and, due to its interdisciplinary nature, it dialogues with theoretical and methodological frameworks of Psycholinguistics, Cognitive Psychology and Neurosciences. Therefore, we adopt an exploratory research design, recall and cloze tests, adapted, with postgraduation students, all native speakers of Brazilian Portuguese. The choice of Macunaíma as the novel and initial motivation for this proposal is due to the fact it is a fantastic narrative, which consists of events, circumstances and characters that are clearly distant types from what is experienced in everyday life. Thus, the novel provides adequate data to investigate the configuration of meaning, within an understanding-based model. We, therefore, seek, to answer questions that are still, generally, scarcely explored in the field of Cognitive Linguistics, such as to what extent is the activation of mental models (schemas and frames) related to the process of understanding narratives? How are we able to build sense even when words or phrases are not part of our linguistic repertoire? Why do we get emotionally involved when reading a text, even though it is fiction? To answer them, we assume the theoretical stance that meaning is not in the text, it is constructed through language, conceived as a result of the integration between the biological (which results in creating abstract imagery schemes) and the sociocultural (resulting in creating frames) apparatus. In this sense, perception, cognitive processing, reception and transmission of the information described are directly related to how language comprehension occurs. We believe that the results found in our study may contribute to the cognitive studies of language and to the development of language learning and teaching methodologies

O império do desentendimento humano: representações da realidade em textos de dalton trevisan

This work has the general proposal of studying the composition of the trevisanian fictional universe, the aesthetic expression engineered to formulate this universe, and last, the representations of reality that emanates from this aesthetic-narrative construction. It seemed to us, however, that it would be impossible to cover, even superficially, so vast and voluminous set of texts as the trevisanian. Therefore, so that we could accomplish this task, and still do it in a way that was, at the same time, plausible and thorough, it was necessary an objective cut within that library. Then we selected a book, representative of the whole trevisanian work, which served as the object of study: Cemitério de Elefantes, 1964, one of the first books of short stories by this author. Within this one, we focused even more our sight, then moving towards what we call a reality forked in paralytic world and world in violence . Supported by the theories and methodologies of Auerbach (2011), Candido (2002, 2006), Adorno (2003), Gennete (1995), Friedman (2002), and still moved by the spirit of Russian Formalism (1973), we built our criticism. Our approach was based then in three steps: first we are dedicated to comment the general context of the trevisanian work, supported strongly by reading two of the biggest critics of his literature, Miguel Sanches Neto and Berta Waldman, secondly, we turn us to comment on the detailed formal construction of language and narrative elements of the trevisanian prose; finally we raised our criticism to the level of reading representations of reality, and then we started to comment the construction of the trevisanian fictional universe, focusing in splitting this universe in paralytic world and world in violence

Representações discursivas de Ficar e Namorar em textos de vestibulandos e pré-vestibulandos

This doctoral thesis investigate the way vestibulandos and pré-vestibulandos construct their discursive representations of Ficar and Namorar in their textual production. At the same time, aims to discuss its implications for the ATD and for the teaching and learning of textual production in the context of Portuguese Language classes. Its theoretical framework is inspired mainly by three sources: textual linguistics, the textual analysis of discourses (ADAM, 2008), as well as by frames semantics (FILLMORE, 2006; FELTES, 2007). The methodology is based on a combination of qualitative and quantitative approaches (VIANNA et al., 2008). The data is composed of 168 empirical texts written by the vestibulandos of PSV/2005 da UFRN, Natal, RN, and by secondary school students who attended Escola Estadual Juscelino Kubitschek (EEJK), Assú, in the 2008 school year. The results indicate different categories of discursive representations of Ficar and Namorar , such as designation of referents, prediction, aspectualization, spatial-temporal circunstances , and metaphor, which reveal the influence of factors such as: the encyclopedic knowledge, the culture, as well as the cognitive components related to textual production. These results point out to the necessity of a teaching practice which enables the interaction among students, the discussion of current themes, as well as the student involvement with different textual genres, mainly the work with textual production in the classroom, so that it enables the students do acquire the textual production strategies. Thus, the overall goal is the (re)construction of their discursive representations, so that they can cope with new contexts of communicative interaction.

O Uso de operações linguístico-discursivas da crítica genética na reescritura de textos

As a professor in Curso de Licenciatura em Letras, from Campus Avançado Profa Maria Eliza Albuquerque Maia (CAMEAM),do Estado do Estado do Rio Grande do Norte (UERN), in the town of Pau do Ferros, in the state of Rio Grande do Norte, we had the chance to carry out several writing activities , as well as guiding re-writing activities for the texts produced. From this experience, we started looking at the need of reflecting upon the writing process in higher education. Thus, we aim at analyzing, in this research, the methodology used in the moment of carrying out the writing practices activities in higher education, investigating, in particular, the rewriting practices, concerning the operations used for carrying out such activities, as well as the sense effects produced from the alterations which were made in the texts. Our theoretical foundation is grounded on a conception of text as a verbal action , what reveals a socio-interactional view of the language (MARCUSCHI, 2008; SAUTCHUK, 2003). As the production of written texts, our research focus, we assume that, for this activity, we deal with distinct figures (active writer and internal reader), so that we can, apart from writing, reflecting upon our writing and, this way, deciding about operations which are carried out to make the alterations which are necessary to the rewriting of our texts (SAUTCHUK, 2003). Still about the theoretical foundations used in this research, we made use of the theories from the Textual Analysis of Discourse (TAD) which discusses the belief on the evidence on the existence of the texts, which is opposite to the fixist view of textuality which believes that the texts exist by themselves. (ADAM, 2008; [2005]2010). Under this perspective, we have also adopted, the concepts which come from genetics criticism which is concerned about the relation between text and genesis, using as objects documents which bring traits of the text in progress, on the ground that the text is the result of work in progress, and the writing practice, on the other hand, as an activity in a continuous movement (HAY, [1975]2002; DE BIASI, [2000]2010; GRÉSILLON, 1989; [1990]2008; [1992]2002; SALLES, 2008a). The methodology in this research is an ethnography-based one, an approach which focuses on the process, as well as is meaning-based. To understand the objectives proposed in our research, we made use of different procedures of collecting data which include an ethnographic study, such as: observation, note-taking, document analysis. The data which were analyzed were collected during the semester of 2008.2, in a first term classroom of Curso de Letras from CAMEAM, when we were able to collect twenty-one written texts and all of them were rewritten based on rewriting activities, what provides a corpus of forty-two texts which will be analyzed based on the linguistics operations identified by Generative Grammar and adopted by Lebrave and Grésillon (2009). From these analyses, we were able to confirm that writing is a process, and rewriting has become an extremely important activity for this process. Still due to these data, we observed that substitution was the most used operation by text authors. We believe that this result is justified by the fact that the substitution, according to what proposes the Genetic Criticism, constitutes the source of all erasure, from which one can easily make a change in writing. Regarding the operations of addition and deletion, we found that they were used in quantitative terms, almost equivalently, which can be explained when we see that the two operations require, by the author of the text, different strategies from those used for the replacement, what includes , respectively, adding or removing a segment. Finally, we found out that the shift operation was the least used, since it works with a segment that will not be replaced, added or deleted, but transferred to another place of text, which requires a greater ability of the author to perform this operation and not compromising the meaning of his/her writing. As a result, we hope to contribute to the reflection on the teaching of writing, considering, in a particular way, those with a Bachelor in Arts. Our analysis will contribute to the teaching of Portuguese language, specifically for activities that guide the production of texts in order to explore with students the ability to rewrite their own text

Didática do plurilinguismo: efeitos da intercompreensão de línguas românicas na compreensão de textos escritos em português

This exploratory study aims to present some readings as Doyé (2003), Carrasco Perea (2003), Melo Araújo e Sá (2004), Chavagne (2009) and Alas-Martins (2010; 2011) which helped to confirm some ways for showing that a plurilingual environment can enable a trend in improving the understanding of written texts in the mother tongue, and can collaborate on a better perception of the world around a person with all their different nuances. The study describes the methodology and some results of our doctoral research that resulted in the insertion of the experimental discipline called Intercomprehension of Romanic Languages (ILR) in the curriculum in the city of Natal / RN / Brazil, and it was justified because of high functional illiteracy degree among young people up to 15 years old according to the educational data from IBGE research on 2010. The results were verified through an experimental action-research which was characterized by Lewin (1946); Nunan (1992); Thiollent (1994) and Trip (2005) in two schools: Professoara Terezinha Paulino de Lima (municipal school) and Professora Ana Julia de Carvalho Mousinho (State of Rio Grande do Norte), with 95 students from the final years of primary education. The corpus of this research was subjected to a series of condensed techniques like the nonparametric test from Kruskal and Wallis (1952) and the parametric test ANOVA as an effort to provide statistical significance to the analysis of the results indicated in the book of ILR activities. The research presented some skill views about reading comprehension of written texts according to perspective of Ringbow (1987), Giacobbe (1990), Alarcão (1991; 2009a and 2009b), Corder (1992), Castellotti (2001) and Degache (2003), and the possibilities of transfer these skills for learning Portuguese as pointed out by Meissner, Klein and Stegmann (2004); it indicates a positive trend towards the understanding of LM according to analyzing the scores of written tests and texts by participants in solving tasks

Histórias de professores universitários sobre ensinar inglês para fins específicos

This research has as its theoretical and methodological assumptions (1) the Narrative Inquiry (CLANDININ; CONNELLY, 2011), (2) the Systemic Functional Grammar (HALLIDAY, 1985, 1994; THOMPSON, 2002; EGGINS, 1994; HALLIDAY; MATTHIESSEN, 2004) and (3) the English for Specific Purposes Approach (ESP - HUTCHINSON; WATERS, 1987; CELANI, 2005; RAMOS, 2005), and its overall objective is to survey the meanings construed by the participants who are ESP practitioners and have not received a specific education to teach this approach at their undergraduation. The field texts and therefore the analises were divided into two distinct groups: the first with data generated from a questionnaire applied to nine professors from a federal university in the northeast of Brazil, which contains open and closed questions about their training and their experiences in teaching ESP; the second group, focusing this time on the experiences of three professors from the first group who were still teaching ESP, with data generated from interviews with these participants in addition to the data generated from their autobiographies and from the researcher´s as well. The computational tool WordSmith Tools 6.0 (SCOTT, 2012) was used to select, organize, and quantify data to be analyzed in the first group of texts, identifying the types of Processes and Participants through the Transitivity System (HALLIDAY; MATTHIESSEN, 2004). The Processes which were more used by the professors in the questionnaire were the Material, followed by the Relational and then the Mental ones, indicating that most professors reported their actions related to the teaching of ESP, rated or evaluated the approach, their training to teach it and their experiences, hence, rarely showing their thoughts and emotions about teaching ESP. Most of the nine professors say they carry out needs analysis, but not all do it according to the authors cited by them or the ones that are considered a reference in this area, such as the ones used in this research as reference. Similarly, their definitions and conceptions of ESP, in most cases, differed from these authors. All the professors claim not having had specific education to teach ESP at the undergraduation. When examining the stories of the four teachers, in the second group of the field texts, based on meaning composition according to Ely, Vinz, Downing and Anzul (2001), it was revealed that the kind of knowledge they report using when they teach ESP is related to their Personal Practical Knowledge and their Professional Knowledge (ELBAZ, 1983; CLANDININ, 1988). In their autobiographies, metaphors were also identified and they represent their concepts of teaching and being a teacher. Through this research, we hope to contribute to the understanding of what teaching ESP might mean for professors in the researched context and also to the continuing education of ESP practitioners, as well as to a review of the curricula in the English language undergraduate courses and of the role of ESP in the training of these professionals

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Treinamento muscular inspiratório para asma: revisão sistemática com metanálise

In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.