Transdisciplinaridade em intervenção precoce na infância : Perceção de uma Equipa Local de Intervenção

As Equipas Locais de Intervenção, compostas por técnicos de diferentes áreas, acolhem, avaliam e intervêm numa perspetiva de Intervenção Precoce centrada nas rotinas da família e nos contextos educativos da criança. Sendo este trabalho realizado essencialmente em equipa - cujos objetivos são comuns - parece haver evidencias de possíveis vantagens mas também constrangimentos inerentes a um trabalho transdisciplinar. Assiste-se cada vez mais a uma crescente especialização ao nível da formação e das práticas profissionais de cada um, o que conduz a um conhecimento mais delimitado a determinada especialidade. Por outro lado, o relacionamento entre as áreas dominadas por cada profissional parecem progressivamente reduzir o distanciamento que habitualmente existia na generalidade dos domínios. O presente estudo pretende contribuir para clarificar a realidade da Intervenção Precoce na Infância, bem como avaliar a implementação de um trabalho de natureza transdisciplinar. A investigação será realizada com dados de natureza qualitativa, através da análise documental e complementada com uma parte empírica baseada nas opiniões e sugestões dos elementos constituintes de uma Equipa Local de Intervenção.

The road map to building new dreams : raising a child with developmental delay or disability

Research on early childhood education emphasises the importance of quality in early childhood intervention. This study examines the quality of Early Childhood Intervention Services based on parents’ experiences raising a child with developmental delay or disability. The study builds on the philosophy of Family-Centred Practice and professionals’ experiences with family-centred interventions. A qualitative case study approach was adopted to gain insight about families who are raising a child with additional needs. Nine in-depth parent-interviews and three focus groups with professionals were conducted in the first two terms of 2010. The case explicates the experiences of parents and professionals who were associated with Specialist Children’s Services in a metropolitan region of Victoria. The research concentrated on the first point of entry to early intervention, the referrals process and the waiting list. It also addressed parents' experiences, priorities and expectations. As a small-scale study, it examined parents’ and children’s needs as well as children’s access to therapy in early intervention. It also investigated community support and parent-professional relationships in the context of early childhood intervention services. The study found that family-centred intervention is beneficial to both parents and children with developmental delay or disability. However, to implement an effective family-centred approach, practitioner support in the form of professional development, supervision and peer mentorship is required to develop professionals’ reflexivity and self-efficacy in family-centred interventions. The study also identified strategies to promote effective practice, gaps in universal and specialised services, and implications for policy.

Trainee underperformance: a guide to achieving resolution

BACKGROUND: Underperformance and the disharmony it can cause are not commonly faced by trainees. However, when it occurs, a process to recognize and manage the issues compassionately must be put in place. METHOD: A literature review was undertaken to outline processes and themes in addressing and resolving these types of issues. A PubMed search using 'surgical underperformance' and 'remedial teaching' was used as a broad template to find papers that illustrated key concepts. One thousand four hundred and fifteen papers were identified. In papers where the titles were in line with the stated topic, 294 abstracts were reviewed. Key papers were used to develop themes. Additional cross-referenced papers were also included where relevant. RESULTS: There can be a variety of reasons for trainee underperformance. The root cause is not always clear. Disharmony can result in a surgical unit during this time. The involved trainee as well as the members of the clinical unit may experience a variety of stressors. A systematic process of management can be used to evaluate the situation and bring some resolution to difficulties in working relationships. CONCLUSION: Early constructive intervention improves outcomes. There should be a process to systematically and compassionately resolve underlying issues. This paper outlines the disharmony that can result from trainee underperformance and offers guidance for resolution to those involved.

Recuperação da função locomotora de cães com discopatia após cirurgia de fenestração discal tóraco-lombar: estudo retrospectivo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age

Objective: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. Methods: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. Results: The prevalence of asthma symptoms in the last 12 months was 11.5%, and 327 (29.4%) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7%) reported having ever been treated: the most common "treatment" was swimming (in 37.3%), and only 12.7% used inhaled corticosteroids. Of the 254 participants (22.7%) with airflow obstruction, only 52 (20.5%) reported having asthma symptoms. Conclusions: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.

Pathogenesis and classification of eosinophil disorders: a review of recent developments in the field

Eosinophils and their products play an essential role in the pathogenesis of various reactive and neoplastic disorders. Depending on the underlying disease, molecular defect and involved cytokines, hypereosinophilia may develop and may lead to organ damage. In other patients, persistent eosinophilia is accompanied by typical clinical findings, but the causative role and impact of eosinophilia remain uncertain. For patients with eosinophil-mediated organ pathology, early therapeutic intervention with agents reducing eosinophil counts can be effective in limiting or preventing irreversible organ damage. Therefore, it is important to approach eosinophil disorders and related syndromes early by using established criteria, to perform all appropriate staging investigations, and to search for molecular targets of therapy. In this article, we review current concepts in the pathogenesis and evolution of eosinophilia and eosinophil-related organ damage in neoplastic and non-neoplastic conditions. In addition, we discuss classifications of eosinophil disorders and related syndromes as well as diagnostic algorithms and standard treatment for various eosinophil-related disorders.

Outcome of aortic surgery in patients with Loeys-Dietz syndrome primarily treated as having Marfan syndrome.

OBJECTIVES Loeys-Dietz syndrome (LDS) is characterized by acute aortic dissection (AAD) at aortic diameters below thresholds for intervention in patients with Marfan syndrome (MFS). The aim was to evaluate the outcome of LDS patients primarily treated as having MFS. METHODS We analysed 68 consecutive patients who underwent surgery between 1995 and 2007 under the assumption of having MFS before retrospectively being screened for LDS when genetic testing became available. These patients were followed up until 2013, and underwent a total of 115 aortic surgeries. RESULTS Genetic testing was performed in 76% of the patients. Sixty per cent of these patients were positive for FBN1 mutations associated with MFS, 20% had no FBN1 mutation and 17% harboured TGFBR1/2 mutations associated with LDS. Mean follow-up was 12.7 ± 7 years. All-cause 30-day, 6-month and 1-year mortality rates were 2.9, 4.4 and 7.3%, respectively. Interestingly, initial presentation with AAD did not differ between LDS and MFS (33 vs 37%, P = 0.48) nor did long-term mortality compared with MFS patients (11 vs 16%, P = 1.0) or within MFS subgroups (FBN1 positive 13%, P = 1.0; FBN1 negative 10%, P = 1.0; not tested 25%, P = 0.62). There was no difference in the need for secondary total arch replacement between LDS and MFS patients (11 vs 14%, P = 1.0), nor within MFS subgroups (FBN1 positive 16%, P = 1.0; FBN1 negative 10%, P = 1.0; not tested 13%, P = 1.0). Total aortic replacement became necessary in 22% of LDS compared with 12% of MFS patients (P = 0.6) and did not differ significantly between MFS subgroups. CONCLUSIONS Although early surgical intervention in LDS is warranted to avoid AAD, the current data suggest that once the diseased segment is repaired, there seems to be no additional burden in terms of mortality or reoperation rate compared with that in MFS patients, with or without confirmed FBN1 mutation.

Biomarkers of pulmonary hypertension in patients with scleroderma: a case-control study.

INTRODUCTION Significant pulmonary vascular disease is a leading cause of death in patients with scleroderma, and early detection and early medical intervention are important, as they may delay disease progression and improve survival and quality of life. Although several biomarkers have been proposed, there remains a need to define a reliable biomarker of early pulmonary vascular disease and subsequent development of pulmonary hypertension (PH). The purpose of this study was to define potential biomarkers for clinically significant pulmonary vascular disease in patients with scleroderma. METHODS The circulating growth factors basic fibroblast growth factor, placental growth factor (PlGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor, and soluble VEGF receptor 1 (sFlt-1), as well as cytokines (interleukin [IL]-1β IL-2, IL-4, IL-5, IL-8, IL-10, IL-12, IL-13, tumor necrosis factor-α, and interferon-γ), were quantified in patients with scleroderma with PH (n = 37) or without PH (n = 40). In non-parametric unadjusted analyses, we examined associations of growth factor and cytokine levels with PH. In a subset of each group, a second set of earlier samples, drawn 3.0±1.6 years earlier, were assessed to determine the changes over time. RESULTS sFlt-1 (p = 0.02) and PlGF (p = 0.02) were higher in the PH than in the non-PH group. sFlt-1 (ρ = 0.3245; p = 0.01) positively correlated with right ventricular systolic pressure. Both PlGF (p = 0.03) and sFlt-1 (p = 0.04) positively correlated with the ratio of forced vital capacity to diffusing capacity for carbon monoxide (DLCO), and both inversely correlated with DLCO (p = 0.01). Both PlGF and sFlt-1 levels were stable over time in the control population. CONCLUSIONS Our study demonstrated clear associations between regulators of angiogenesis (sFlt-1 and PlGF) and measures of PH in scleroderma and that these growth factors are potential biomarkers for PH in patients with scleroderma. Larger longitudinal studies are required for validation of our results.

Implementación de una arquitectura de componentes para un sistema de apoyo a la toma de decisiones en Atención Primaria

Este Proyecto Fin de Grado tiene como objetivo fundamental el perfeccionamiento y puesta en explotación de un sistema de ayuda a la decisión que evalúa el desarrollo del lenguaje en niños de 0 a 6 años de edad. Este sistema está formado fundamentalmente por una aplicación diseñada y construida mediante una arquitectura de componentes de software modular y reutilizable. La aplicación será usada por los pediatras para realizar evaluaciones del desarrollo del lenguaje infantil y además por los neuropediatras, logopedas y miembros de equipos de Atención Temprana para consultar las evaluaciones y validar las decisiones propuestas por el sistema. El sistema es accesible vía web y almacena toda la información que maneja en una base de datos. Asimismo, el sistema se apoya en un modelo conceptual u ontología desarrollado previamente para inferir las decisiones adecuadas para las evaluaciones del lenguaje. El sistema incorpora las funciones de gestión de los usuarios del mismo. ABSTRACT This Grade End Project has as fundamental objective the improvement and deployment of a decision support system for evaluating children language development from 0 to 6 years of age. This system is mainly formed by an application designed and built using a modular and reusable software component architecture. The application will be used by pediatricians for evaluating children´s speech development and also by neuro-pediatricians, speech therapists and early childhood intervention team members, for consulting previous evaluations and for validating system´s proposed decision. The system is web based and stores its information in a database. Likewise, the system is supported by a conceptual model or ontology previously developed to infer the appropriate decision for language evaluation. The system also includes user management functions.

Identificação do risco de deterioração fisiológica no pré-hospitalar

Enquadramento – A Early Warning Scores é uma escala de alerta, baseada num sistema de atribuição de pontos (scores) aos parâmetros vitais e deterioração do SNC, sendo a sua principal finalidade a identificação precoce do risco de deterioração fisiológica do doente. Objetivos – Determinar os parâmetros da escala que foram avaliados; identificar a periodicidade de avaliação dos parâmetros da escala; determinar as situações identificadas como risco de deterioração fisiológica; avaliar as propriedades psicométricas da escala Early Warning Scores (validade e fiabilidade). Material e Método – Estudo quantitativo e descritivo-correlacional, cuja população alvo consistiu nos doentes vítimas de acidente ou doença súbita, submetidos a atendimentos por parte de enfermeiros afetos ao INEM, nomeadamente nas ambulâncias de Suporte Imediato de Vida, mediante ativação via 112. O instrumento de avaliação utilizado consiste na Escala Early Warning Scores. Resultados – Verificou-se que o índice de fiabilidade se traduziu num valor de alfa de Cronbach, para a globalidade da escala, fraco (α=0.462). Concluiu-se que houve uma redução progressiva dos scores, em termos de risco, indicando a ocorrência de uma deteção precoce da degradação clínica dos 214 doentes, o que se traduziu numa atuação mais eficaz no pré-hospitalar. Conclusão - A redução progressiva dos scores, em termos de risco ao longo dos três momentos de avaliação com a Early Warning Scores, sugere que houve uma deteção precoce da degradação clínica dos doentes, resultando numa atuação mais eficaz no pré-hospitalar. Palavras-chave: Pré-hospitalar; Risco de deterioração fisiológica; Early Warning Scores.

Relationship between Comprehensive School Readiness Profiles and Longer-Term Academic Growth

Thesis (Master's)--University of Washington, 2016-06

Down Syndrome Across the Life Span

Beyond the myths: representing people with Down syndrome / Jan Gothard -- Learning in young children with Down syndrome: public perceptions, empirical evidence / Jennifer G. Wishart -- Self-regulation in children and young people with Down syndrome / Sheila Glenn and Cliff Cunningham -- What matters most? A reflection on a quarter century of early childhood intervention / Robin Treloar and Susan Cairns -- Making inclusion work: improving educational outcomes for students with Down syndrome in the regular classroom / Loretta R. Giorcelli -- Cognitive development and education: perspectives on Down syndrome from a twenty-year research programme / Susan Buckley and Gillian Bird -- Broadening approaches to literacy education for young adults with Down syndrome / Christina E. van Kraayenoord ... [et al.] -- Numeracy and money management skills in young adults with Down syndrome / Sandra Bochner ... [et al.] -- Life styles of adults with Down syndrome living at home / Anne Jobling and Monica Cuskelly -- Some studies involving individuals with Down syndrome and their relevance to a quality of life model / Verity Bottroff ... [et al.] -- From autonomy to work placement / Anna Contardi -- An appreciative inquiry about adults with Down syndrome / Susanne Muirhead -- Multiple perspectives of family life / Monica Cuskelly ... [et al.] -- Verbal-motor behaviour in persons with Down syndrome / Brian K.V. Maraj ... [et al.].

Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.

The effects of an individualized clinical reading program on kindergarten and beginning grade one at -risk students: A longitudinal study

This was a longitudinal study that investigated the effects of an early intervention program which was implemented at the beginning of formal reading instruction and used individual clinical instruction with at-risk students. A total of 37 private school students were divided into three cognitive ability groups and evaluated over a three year period using the reading comprehension and study skills sections of the Stanford Achievement Tests (1982) administered annually. At-risk students were matched with a normal peer group for gender, cognitive ability, and time at school. Results showed there were no significant differences in the reading comprehension scores for program and non-program students. However, the at-risk group showed significantly lower scores on the study skills section at the end of grade three. These results indicate that early reading intervention for at-risk students promotes compensation and helps develop processes for adequate reading comprehension but these students continue to have weaker linguistic abilities. ^

A cartola mágica : um instrumento de intervenção em perturbações da linguagem

"As perturbações da linguagem apresentam um elevado risco para dificuldades de aprendizagem e podem comprometer a inserção escolar e social das crianças afetadas. Quando a fala não se constitui como um meio de linguagem expressiva, torna-se muito importante proporcionar à criança uma intervenção terapêutica precoce.Com este propósito foi criado um instrumento lúdico-pedagógico para a terapia de fala, capaz de dar suporte conjunto aos cinco domínios linguísticos e que é facilmente apreendido pela criança, favorecendo a sua aprendizagem. O instrumento de intervenção designado por “A Cartola Mágica” é personificado num gato com uma cartola anatomicamente compartimentada em forma de gavetas, simbolizando os cinco domínios da linguagem, destinado a crianças com idades compreendidas entre os 5 e os 8 anos. O instrumento pode ser utilizado em várias vertentes linguísticas, de acordo com os objetivos terapêuticos pretendidos. O instrumento apresenta como limite a portabilidade do modelo criado e, como alcance empírico, o fato de incluir todos os domínios da linguagem e ser de fácil aplicação em settings terapêuticos restritos."