38 resultados para Lesões por esforços repetitivos (LER)

em Universidade Federal do Rio Grande do Norte(UFRN)


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Objetivo: analisar o estado da arte dos aspectos diagnósticos, periciais e jurisprudenciais das LER/DORT (Lesões por Esforços Repetitivos / Distúrbios Osteomusculares Relacionados ao Trabalho) no Brasil. Materiais e Método: trata-se de pesquisa descritiva, de natureza qualitativa, com formato documental, utilizando-se a técnica de análise de conteúdo. A avaliação evolutiva da legislação previdenciária relacionada as LER/DORT foi realizada através da pesquisa no banco de dados disponibilizado pelo Governo Federal e mediante a consulta ao DATAPREV/Sislex. A avaliação dos aspectos diagnósticos foi instrumentalizada através, principalmente, de artigos científicos publicados entre 2003 e 2008, nas línguas portuguesa, inglesa, espanhola e francesa, relacionados com os métodos de diagnósticos complementares das LER-DORT (ressonância magnética, tomografia computadorizada, ultrassonografia e eletroneuromiografia). As jurisprudências foram obtidas através da busca dos julgados sobre o tema, entre 2003 e 2008, pertencentes ao Supremo Tribunal Federal, Superior Tribunal de Justiça, Tribunais Regionais Federais, Tribunal Superior do Trabalho e Tribunais Regionais do Trabalho. Resultados: foram identificados 48 artigos abordando os aspectos diagnósticos das LER-DORT, observando-se que os exames por ressonância magnética, ultrassonografia e eletromiografia demonstraram ser mais efetivos, dentro das suas especificidades, para a complementação do exame clínico de patologias relacionadas às LER-DORT. A análise das 123 jurisprudências selecionadas demonstrou, de forma geral, que as LER-DORT equiparam-se ao acidente de trabalho, devendo apresentar nexo de causalidade (atestado através de laudo médico-pericial) e, ainda, ensejam a ação por danos morais, a qual, devido à EC nº 45 passou a ser competência da Justiça do Trabalho. O Estado da arte dos aspectos periciais encontra-se representado pela vigência da Instrução Normativa n. 98/2003, a qual traz como aspecto fundamental a determinação de novos parâmetros a serem considerados na definição de um quadro de LER-DORT, dispondo, ainda, sobre a conduta ética que deve ser adotada pelo médico perito, bem como chama a atenção para a necessidade dessas doenças do trabalho serem comunicadas às autoridadades competentes, através da emissão da Comunicação de Acidente de Trabalho (CAT). Conclusão: as LER-DORT representam, hoje, um problema de importante impacto, não apenas previdenciário, mas também econômico em diversos países, nos quais o Brasil encontra-se inserido. Estudos sobre o estado da arte relacionados às LER-DORT são fundamentais para auxiliar na construção de um modelo crítico e consciente que colabore com a garantia de sustentabilidade do sistema previdenciário no Brasil

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The increasing prevalence of Repetitive Strain Injury / Work-Related Musculoskeletal Disorders (RSI / MSDs) has been explained by changes in the work that has been characterized by setting goals and productivity. This fact does not take into account the psycho-physiological characteristics of workers who become ill as a result of professional activities engaged in and also the adverse conditions in which his work was done. This study aimed to analyze the RSI / MSDs reported in the state of Rio Grande do Norte, Brazil, 2010-2014 compared to the profile of the population, epidemiological aspects and features of these diseases. It is a descriptive epidemiological cross-sectional study using secondary data obtained in the Notifiable Diseases Information System (SINAN) in May 2015 was used as the area covered by the Rio Grande do Norte. Data were collected regarding the grievances of work-related RSI / MSDs, assigned by the Worker's Health Reference Center (CEREST) of the State Health Department. Data were processed with the help of Microsoft Excel® 2013 and presented in tables in absolute frequency (n) and relative frequency (%). The results showed a total of 403 notifications of RSI / MSDs, where the vast majority 72% (290) was recorded in Natal. Regarding the profile of notified employees, 88.59% (357) have aged between 25 and 54 years, 62.78% (253) were female, and in relation to education, 31.51% (127) had high school complete. The most affected occupations were seamstresses (the clothing industry) with 24.97% (97), followed by masons, construction with 3.23% (13) and cashiers with 2.99% (12). About the work situation, 75.93% (306) had a formal contract, however, were sent to Communications Occupational accidents (CAT) only 67% (270) of the cases. Regarding the signs and symptoms, pain and limitation of movement were the most mentioned respectively with 98.01% (395) and 95.04% (383) of notifications. Notifications, 94.29% (380) showed exposure to repetitive movements in their workplace. The most frequent specific diagnoses were synovitis and tenosynovitis (CID F 65), with 30.02% (121) of notifications, followed by back pain (CID F 54) to 19.35% (78) and shoulder injuries (ICD M 75) with 15.88% (64). They were away from work 81.64% (329) of workers reported with RSI / MSDs. Evolution more prevalent among cases was temporary disability with 75.68% (305). It was concluded that the SINAN is a database of potential to characterize the profile of RSI / MSDs, requiring, however, an improvement in the coverage of records and data quality. In addition, this study reflects the need to implement protection strategies to workers by companies, signaling promotion, prevention and rehabilitation aimed at reducing these injuries and the improvement of occupational health indicators in Rio Grande do Norte.

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Silveira , E. J. D. et al. Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos. J. Bras. Patol. Med. Lab., v. 45, n. 3, p. 233-238, jun 2009. ISBN 1676-2444.

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RESUMO: Objetivo: Estudo com o objetivo de observar a influência da nicotina, aplicada pela via subcutânea, em pulmões de ratos. Métodos: Foram utilizados 20 ratos Wistar pesando 235±35g, separados aleatoriamente em 2 grupos iguais. O grupo I (n=10) recebeu nicotina na dose de 2 mg/ Kg/dia pela via subcutânea durante 20 dias e o grupo II (n=10) recebeu placebo pela mesma via de administração. Resultados: Os resultados mostraram que no grupo I ocorreu broncopneumonia em 3 (30%) ratos, leucocitose alveolar em 10 (100%) e leucocitose septal em 7 (70%). Atelectasia foi encontrada em 2 (20%). Transformados em escores, os dados totalizaram 52 pontos. Os escores das alterações observadas nos pulmões do grupo II atingiram 11 pontos (p<0,05). Conclusão: Os dados permitiram concluir que o uso da nicotina por via subcutânea contribuiu para o aparecimento de lesões pulmonares em ratos, em número e intensidade significativamente maiores do que nos animais considerados controles.

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Objetivo: Estudo com o objetivo de observar a influência da nicotina, aplicada pela via subcutânea, em pulmões de ratos. Métodos: Foram utilizados 20 ratos Wistar pesando 235±35g, separados aleatoriamente em 2 grupos iguais. O grupo I (n=10) recebeu nicotina na dose de 2 mg/Kg/dia pela via subcutânea durante 20 dias e o grupo II (n=10) recebeu placebo pela mesma via de administração. Resultados: Os resultados mostraram que no grupo I ocorreu broncopneumonia em 3 (30%) ratos, leucocitose alveolar em 10 (100%) e leucocitose septal em 7 (70%). Atelectasia foi encontrada em 2 (20%). Transformados em escores, os dados totalizaram 52 pontos. Os escores das alterações observadas nos pulmões do grupo II atingiram 11 pontos (p<0,05). Conclusão: Os dados permitiram concluir que o uso da nicotina por via subcutânea contribuiu para o aparecimento de lesões pulmonares em ratos, em número e intensidade significativamente maiores do que nos animais considerados controles

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Este trabalho objetivou uma reflexão sobre a ação mediadora no processo de ensino-aprendizagem da leitura, por mim vivenciada no Núcleo de Educação Infantil (NEI/UFRN) junto a crianças de 6/7 anos, tendo como proposta explicitar os elementos orientadores necessários a esse processo, que se traduzam como referência a outras práticas educativas. Sua realização pressupôs as seguintes questões: que conteúdos estão envolvidos no ensinoaprendizado da leitura? Como os alunos aprendem a ler? Que tarefas são instrumentais no ensino e aprendizado da leitura? Nele foi adotada a concepção de leitura enquanto atribuição de significados a um texto escrito através do processo interativo entre leitor e texto, guiado pelos objetivos/finalidades deste leitor. Adotou os princípios metodológicos da abordagem qualitativa, entre cujas características salienta-se a primazia do interesse pelo processo do que simplesmente pelos resultados ou produto. Seus resultados evidenciaram que a leitura, enquanto prática cultural, pode ser aprendida na escola infantil, espaço de apropriação de saberes mediados pela cultura. Constatou-se que, a exemplo das demais aprendizagens, o aprendizado da leitura implica numa atividade mediada em que o professor, administrando e organizando o meio social educativo, cria espaços de diálogo para as muitas vozes presentes nesse meio. Gera, desse modo, um contexto polifônico, dialógico e de alteridade pela ação de planejar/avaliar/replanejar a sua atuação e a de seus alunos. A relevância deste estudo concerne à intenção de socializar uma vivência, cuja tônica é a reflexão sobre a leitura enquanto prática cultural e as estratégias de ensinar e aprender a ser leitor.

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OBJECTIVE: Evaluating the kit-Bh performance in carrying out of breast biopsies. METHODS: They were randomly selected a sample of 30 patients with breast cancer undergoing mastectomy, based on the results of a pilot study from February 2008 to April 2010. They were excluded women with had not palpable, stone-hard consistency tumors, previous surgical manipulation or that contains liquid. Using the helicoid biopsy Kit (kit Bh) and an equipment Core biopsy with cannula and needle and 14 gauge respectively, it was collected a fragment of sound equipment in the area and in tumors in each specimen, totaling 120 fragments for histological study. For data analysis, it was defined a 95% confidence level and used the SPSS-13 version, the Kappa index and the parametric Student t test. RESULTS: Mean age of patients was 51.6 years (± 11.1 years). The infiltrating ductal carcinoma showed a higher incidence, 26 cases (86.7%). The Core biopsy had a sensitivity of 93.3%, specificity of 100% and accuracy 96.7%, while the helicoid biopsy had a sensitivity of 96.7%, specificity of 100% and accuracy 98.3%. By comparing the histology of tumors and the fragments of biopsies, there was high degree of agreement in diagnoses (kappa of 0.93 with p <0.05) CONCLUSION: Both devices provided the histological diagnosis of lesions with high accuracy. Results of this study showed that the helicoid biopsy is a reliable alternative in 22 the preoperative diagnosis of breast lesions. Further studies in vivo better will define the role of Kit Bh in the diagnosis of these lesions

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O desenvolvimento do esporte paraolímpico nacional e internacional tem estimulado maior participação das pessoas com deficiência em praticar atividades desportivas, exigindo dos atletas incrementos na intensidade e freqüência nos treinamentos e competições, o que impulsiona, ainda mais, os índices de lesões esportivas traumato-ortopédicas. Objetivamos neste estudo descritivo analisar as lesões traumato-ortopédicas mais frequentes nos atletas paraolímpicos, sua localização nos segmentos corporais, correlacionando-as com as modalidades esportivas praticadas pelos integrantes das Seleções Brasileiras Paraolímpicas. O presente estudo foi realizado com 82 atletas paraolímpicos da Seleção Brasileira de Atletismo, Halterofilismo, Natação e Tênis de mesa, de ambos os sexos, com deficiências motoras, visual e intelectual, participantes dos Campeonatos Mundiais, no ano de 2002, sendo os mesmos selecionados de forma não probabilística intencional os quais atenderam os critérios de inclusão e exclusão estabelecidos para o estudo. Para a avaliação clínica das lesões traumato-ortopédicas foram utilizados como instrumentos de medida o Prontuário do Departamento Médico do Comitê Paraolímpico Brasileiro (técnica da observação através da história clinica esportiva do atleta / anamnese e exame físico), entrevistas com os atletas e exames complementares das lesões traumato-ortopédicas quando necessárias. Os resultados do estudo com os atletas paraolímpicos revelaram prevalência de lesões no atletismo (MMII = 64,9%, coluna = 19,3% e MMSS = 15,8%); halterofilismo (coluna = 54,5%, MMSS = 36,4% e MMII = 9,1%); natação (MMSS = 44,4%, coluna = 38,9 e MMII = 16,7%) e tênis de mesa (MMSS = 56%, coluna36% e MMII = 8%), com predomínios das lesões músculotendineas em todos os esportes pesquisados. Os resultados apresentados nos permitem concluir que em todos os esportes pesquisados os atletas paraolímpicos apresentaram um predomínio das lesões músculo-tendíneas, tendo como localização no atletismo, lesões nos membros inferiores, no halterofilismo na coluna vertebral e membros superiores, na natação e no tênis de mesa, nos membros superiores e coluna vertebral

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PURPOSE: To evaluate the capacity of clofazimine (CFZ) to control cutaneous activity of systemic lupus erythematosus (SLE), compared with chloroquine diphosphate (CDP). METHODS: A prospective, randomized, controlled, double blind clinical trial was carried out in thirty-three patients with SLE and cutaneous lesions (malar rash and/or discoid lupus and/or subacute cutaneous lupus), after approval by the respective Ethics Committee. Sixteen patients received clofazimine - 100mg/day (CFZ group) and 17 received chloroquine diphosphate - 250mg/day (CDP group), during six months. Both groups applied broad-spectrum sunscreens twice a day. The dose of prednisone was kept stable during the study. Cutaneous lesions were evaluated by 2 blinded observers and photographed at baseline and at months 1, 2, 4 and 6. RESULTS: Thirty-three patients began and 27 completed the 6 months of treatment. The groups were homogeneous and comparable in terms of demographic and clinical characteristics. Five CFZ-patients and one CDP-patients dropped out due to severe flare of disease requiring other treatment. At the end of the study, 12 CFZ-patients (75%) and 14 CDP-patients (82,4%) presented complete or near-complete remission of skin lesions; intention-to-treat analysis showed no significant difference in the response rates between groups. Side effects in both groups were frequent, but patients didn t have to discontinue the drugs. CONCLUSIONS: Clofazimine and chloroquine were effective in controlling cutaneous lesions in SLE patients

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Esta tesis de maestría es el resultado de una investigación de carácter cualitativo y etnometodológico, realizada entre agosto de 2003 y junio de 2004, en una escuela primaria estatal, ubicada en Natal RN (Brasil). Su objetivo fue investigar la recepción de la lectura de literatura por parte de una maestra a la que, según reveló, no le gustaba leer y no se consideraba lectora de literatura. Se buscó investigar la mediación que le posibilitara llegar a ser lectora, comprender cuáles son los aspectos que influyen en la relación entre el lector en formación y la lectura de literatura, y verificar cómo repercute ese proceso de formación en la práctica docente de la maestra estudiada. Los procedimientos de investigación fueron aplicados con flexibilidad, tomando en cuenta el proceso de formación lectora de la docente. Los principales instrumentos utilizados fueron dos entrevistas semi-estructuradas, realizadas con la maestra, y notas de campo, que adquirieron el formato de un diario de investigación. En la primera etapa, fueron realizadas treinta sesiones de lectura, para posibilitar el acercamiento de la maestra a diferentes textos literarios. En la segunda etapa, fueron realizados tres encuentros de planificación con la maestra y cinco clases de lectura con sus alumnos. El análisis focaliza la recepción de la lectura literaria por parte de la maestra, abordando diferentes aspectos: su historia en relación con la lectura; la identificación, el contrato ficcional y la relación texto-vida; las previsiones y sus verificaciones; la mediación y el andamiaje brindados para introducir a la maestra en la cultura de la lectura. Se focaliza también la relación entre sus roles de lectora y de mediadora de lectores. Los fundamentos teóricos se basan, principalmente, en Coulon (1995a, 1995b), Vigotsky (1989, 1991, 2003), Graves y Graves (1995), Smith (1991), Jauss (2002), Iser (1996, 1999) y Amarilha (1996, 2001). Como resultados de este trabajo, se destacan el interés de la maestra, la manera en que ella se involucró con las historias leídas mediante procesos de identificación con algunos personajes y la relación que estableció entre los textos y su historia; esos procesos indican avances significativos en su vínculo con la lectura de literatura. La mediación ocupó un papel central en la consecución de aquellos avances. Vale destacar que la relación texto-vida fue establecida por la maestra con cierta ingenuidad, lo que le impidió vivenciar lo ficcional como una actividad lúdica. Se considera necesario un contacto más intenso y regular con textos de ficción, para que la docente pueda distanciarse de su vida cotidiana y adquirir la autonomía y la conciencia transformadora que le permitirán ir y volver de la realidad a la ficción, enriqueciéndose, sin confundirlas. Ese contacto no depende sólo de una actitud individual y personal de la maestra, sino del contexto institucional y social en el cual está inmersa. En ese sentido, la segunda etapa del trabajo de campo demostró que el pasaje de la formación lectora inicial a una acción pedagógica adecuada es complejo; los procesos no son lineales y, todavía, queda un largo camino por recorrer

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In Reading Television: Limits of the course TV in the School and the Challenges of Today in Sergipe , we had as objective to detect that type of critical reading of the cultural texts produced by the television, professionals of the education of the public net of the basic and average education of the state of Sergipe that all had concluded its 3 (three) modules carries through. We were effectively tutorial of the first edition of this course of extension in the distance and witness some inconsistencies in its application, moment where the instigated investigation appeared: ahead of the current necessity of if understanding with a critical sense, the paper that plays it measured them in orchestration of the globalizado world, that type of critical reading of the audiovisual language is capable to carry through a professional of the education that participated of a course of this nature? Beginning with documental analysys and qualitative metodology we try to analyse in four chapters, since the origins and motivations of this course, to the opinions of 10 (ten) former course students about the approaches of the same thematic subject by two different television new programs, without missing the opinions of the tutors about the conditions in which were made 4 (four) consecutive editions of the course in Sergipe nor the concrete relationships estabilished by the former course students and the audiovisual on their everyday routine both at home and at work. We conclude that the reading made by the former course students is based on common sense and then not satisfactory to the requirements of this task nowadays, and at the same time we point out that the course failed, for it presented severe issues in terms of management and operations in its practical application to distance, by priorizing quantity over quality, by linking itself to a deficient technical structure, by not beholding the diosyncrasies nor the fundamental videos the teachers have access everyday and that it all had direct relation with the attachment of this course to a verticalized policy of technologization of brazilian education.

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This work is about the historical and cultural assumptions inserted in the contents of literacy of the Campanha de Pé no Chão Também se Aprende a Ler, a movement of culture and popular education, developed in the State of Rio Grande do Norte in the period between 1961 and 1964. The hypothesis is the one of the existence of a romantic-political ideology which permeated a national developmentalist conception sited in its didactic-pedagogic instrument of literacy, the Book of Lecture of De Pé no Chão Também se Aprende a Ler/RN (1963). It has the aim to understand how the popular critical consciousness marked by conceptions of culture and popular education in its social, cultural and ideological relations, happened. Analyses the object of study by the symbolical cartography, methodological procedures which have as principles to retire from an antecedent source implicit meanings that can discover new realities, articulating the keywords of that document to the ideology that surrounded the Campanha de Pé no Chão Também se Aprende a Ler /RN. As results, the research showed that, considering the historical-cultural assumptions of the national developmentalist thought sited in the studied Book of Lecture, the conditions of the political-cultural context and of the advance of the Brazilian national industry on the beginning of the 1960th , admitted a process of social integration lavished by the popular literacy on the Campanha de Pé no Chão/RN, linked with the possibility of transition of the popular conscience, in a romantic-political perspective of the culture and the popular education

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The skin cancer is the most common of all cancers and the increase of its incidence must, in part, caused by the behavior of the people in relation to the exposition to the sun. In Brazil, the non-melanoma skin cancer is the most incident in the majority of the regions. The dermatoscopy and videodermatoscopy are the main types of examinations for the diagnosis of dermatological illnesses of the skin. The field that involves the use of computational tools to help or follow medical diagnosis in dermatological injuries is seen as very recent. Some methods had been proposed for automatic classification of pathology of the skin using images. The present work has the objective to present a new intelligent methodology for analysis and classification of skin cancer images, based on the techniques of digital processing of images for extraction of color characteristics, forms and texture, using Wavelet Packet Transform (WPT) and learning techniques called Support Vector Machine (SVM). The Wavelet Packet Transform is applied for extraction of texture characteristics in the images. The WPT consists of a set of base functions that represents the image in different bands of frequency, each one with distinct resolutions corresponding to each scale. Moreover, the characteristics of color of the injury are also computed that are dependants of a visual context, influenced for the existing colors in its surround, and the attributes of form through the Fourier describers. The Support Vector Machine is used for the classification task, which is based on the minimization principles of the structural risk, coming from the statistical learning theory. The SVM has the objective to construct optimum hyperplanes that represent the separation between classes. The generated hyperplane is determined by a subset of the classes, called support vectors. For the used database in this work, the results had revealed a good performance getting a global rightness of 92,73% for melanoma, and 86% for non-melanoma and benign injuries. The extracted describers and the SVM classifier became a method capable to recognize and to classify the analyzed skin injuries

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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

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Este trabajo busca analizar cómo algunos aspectos presentes en la obra de ficción del escritor catalán Enrique Vila-Matas permiten pensar las prácticas de la escritura literaria contemporánea. A partir de una forma híbrida que reconsidera las relaciones tanto entre los géneros como entre los discursos crítico y de ficción, la obra del autor se propone reflexionar sobre sus propias posibilidades en el contexto sociocultural contemporáneo. De este modo, a través de una ficción que muchas veces adquiere los atributos del ensayo, Vila-Matas trae al centro de sus enredos la discusión de cuestiones relacionadas con los impases de una escritura que vuelve su atención para el destino de una tradición literaria desvinculada de los preceptos meramente mercadológicos contemporáneos. Su manera crítica de abordar la literatura y la experimentación en busca de nuevas posibilidades permite asociarlo tanto a Laurence Sterne como al proyecto literario de Jorge Luis Borges. Estos autores tienen propuestas que tratan de superar los límites del texto, ya que ahí está el deseo de acogerse a la ficción para demostrar la inestabilidad de los elementos de una cultura, apropiándose y desestabilizando los discursos y las claras distinciones entre los saberes. En este sentido, las diversas formas en que Vila- Matas se apropia de los textos de otros y construye una obra de carácter fuertemente intertextual denuncian jerarquizaciones y modos de circulación de textos que permiten aproximarse de la tensión existente entre temas como influencia, citación, prácticas de lectura y escritura