Hiperactividade... quando todos aprendem juntos

A inclusão de alunos com Necessidades Educativas Especiais, na especificidade «Distúrbio Hiperactividade com Défice de Atenção» em turmas do Ensino regular, requer alguma prudência, pois as opiniões são muitas e por vezes controversas. A inclusão, é um modelo educacional, que contém vantagens e desvantagens na sua aplicação. No entanto, um modelo educacional que contemple a inclusão deve ser dirigido a todos os alunos, com vista ao sucesso e tendo em conta o ritmo próprio de cada um. Neste âmbito, avaliar o conhecimento dos docentes acerca da hiperactividade, conhecer a opinião dos professores relativa ao processo de inclusão de alunos com DHDA, bem como a utilização de terapias e ainda o modo como os professores olham para a resposta que a escola dará no futuro às crianças hiperactivas foi a meta traçada para a nossa investigação. A amostra foi constituída por 50 professores dos vários níveis de ensino que residem na cidade do Fundão. O questionário foi o instrumento de trabalho utilizado para avaliar os dados do estudo. Como resultados do estudo, verifica-se que de um modo geral todos os docentes conhecem o distúrbio DHDA e as causas que indiciam este distúrbio, sendo o factor hereditário o mais apontado. Na questão da inclusão de alunos portadores de DHDA todos os inquiridos consideram válido o seu percurso no ensino regular. Referem, também que a experiência profissional, a formação e as terapias são também uma mais-valia na relação com estes alunos. O trabalho desenvolvido com estas crianças é caracterizado pelos docentes como difícil mas motivante. Numa panorâmica futura para a Educação Especial os docentes entendem ser necessário produzir mudanças que vão ao encontro destes alunos. O trilho percorrido é positivo, porém, muito mais temos que percorrer para evitar a discriminação a todos aqueles a quem a vida trocou as voltas e nasceram diferentes, oferecendo a todos as mesmas oportunidades, que é uma escola inclusiva.

Estratégias de intervenção educativa junto de alunos com hiperatividade e problemas de atenção

A Perturbação de Hiperatividade e Défice de Atenção (PHDA) é um distúrbio que, segundo a literatura, afeta entre 3-7% das crianças em idade escolar e que consiste numa tríade de desatenção, hiperatividade e impulsividade. Este distúrbio é prevalente e para os atingidos pode ter consequências gravosas sendo o insucesso escolar um dos primeiros obstáculos. Muitas vezes entendidas pela classe docente como falta de educação e preguiça, estas características não recebem a atenção devida. Baseado num aluno do 8º ano com diagnóstico de PHDA do tipo misto desde os 5 anos de idade, este projeto destinou-se a estudar sumariamente a PHDA e a encontrar, aplicar e avaliar a eficácia de um conjunto de estratégias de aprendizagem que, numa perspetiva inclusiva, permitissem quer ao aluno quer ao grupo turma desenvolver os seus potenciais de aprendizagem. O aluno não se encontra abrangido pelo Decreto Lei 3/2008 mas apresentou insucesso escolar no 7º ano que quase comprometeu a sua progressão. Integra uma turma de dezasseis alunos que inclui três alunos abrangidos pelo referido decreto sendo um de currículo específico individual. Este projeto desenvolveu-se no primeiro período do ano letivo 2012-2013 e possui duas vertentes: a tutoria individual - num tempo semanal – assumido na qualidade de diretora de turma, e o espaço de sala de aula curricular de Físico-Química – em três tempos semanais – da qual a autora do presente trabalho é docente. O projeto de tutoria, sugerido pelo psicólogo que acompanha o aluno, destinou-se à implementação de um Programa de Promoção da Função Cognitiva e de Métodos e Hábitos de Estudo incidindo nos seguintes domínios: componente motivacional, componente comportamental, componente cognitiva, autoconhecimento e autoavaliação, e planeamento de uma metodologia de estudo mais eficaz. Em sala de aula o enfoque esteve na componente motivacional para o estudo da disciplina com o intento de otimizar as funções executivas de Ativação, Foco e Esforço mencionadas por Brown (2009), e na atribuição de significado aos conteúdos estudados para trabalhar a Memória de curto e longo prazo. Para a abordagem dos vários temas utilizaram-se recursos variados procurando respeitar os vários estilos de aprendizagem mas o recurso a objetos e atividades experimentais foram os que se revelaram mais eficazes. No final desta intervenção, a avaliação do período em estudo revelou um aluno mais motivado e participativo na generalidade das disciplinas e especialmente em Físico-Química onde obteve classificações acima da média da turma. PALAVRAS CHAVE: Perturbação de hiperatividade e défice de atenção, inclusão, estratégias de intervenção em sala de aula.

A Study on the Efficiency of Synbiotics for Prevention and Control of Diarrhoea in 21 Dogs Submitted to Radiotherapy

A synbiotic is a formulation containing both probiotics and prebiotics. This study aims to evaluate the effect of supplementation with a synbiotic containing Enterococcus faecium strain E1707 (NCIMB 10415) in preventing or controlling diarrhoea and other gastrointestinal signs in boarded canine radiotherapy patients. A double-blind, randomized, placebocontrolled clinical trial was carried out in 21 adult dogs undergoing radiotherapy and boarded for a duration period of 2 to 3 weeks to treat their cancers. Dogs were randomly divided between two groups: A and B, the synbiotic and placebo group, respectively. The content of the sachets was added to the food once daily. Faecal score was assessed daily, and dogs were also monitored for the development of diarrhoea and other gastrointestinal signs such as weight loss, reduced appetite and vomiting. The results from descriptive statistics seem to favour group B, however these findings were not validated with inferential statistics due to insufficient statistical sample power. Because of this, it is not possible to make conclusions about the benefits of synbiotic as supportive treatment for dogs undergoing radiotherapy. All results should be considered to be preliminary, until they are elucidated by further animal inclusion.

Prebiotic effects: metabolic and health benefits

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies.

Visceral tissue mass and rumen volume in dairy cows during the transition from late gestation to early lactation

The objectives were to measure the effects of transition and supplemental barley or rumen-protected protein on visceral tissue mass in dairy cows and the effects of transition and barley on rumen volume and liquid turnover. Cows were individually fed a grass silage-based gestation ration to meet energy and protein requirements for body weight stasis beginning 6 wk before expected calving. A corn silage-based lactation ration was individually fed ad libitum after calving. In the visceral mass study, 36 cows were randomly assigned to one of 3 dietary treatments: basal ration or basal ration plus either 800 g dry matter (DM) of barley meal per day or 750 g DM of rumen-protected soybean protein per day. Cows were slaughtered at 21 and 7 d before expected calving date or at 10 and 22 d postpartum. Visceral mass and rumen papillae characteristics were measured. Diets had little effect on visceral mass. The mass of the reticulo-rumen, small intestine, large intestine, and liver was, or tended to be, greater at 22 d postpartum but not at 10 d postpartum before DM intake had increased. Rumen papillae mass increased at 10 d postpartum, perhaps in response to increased concentrates. Mesenteric fat decreased after calving, reflecting body fat mobilization. Ten rumen-cannulated cows were fed the basal gestation ration alone or supplemented with 880 g of barley meal DM. Rumen volumes and liquid dilution rates were measured at 17 and 8 d before calving and at 10, 20, and 31 d postpartum. Feeding barley had no effects. After calving, rumen DM volume and liquid dilution rate increased, but liquid volume did not increase. Changes in gastrointestinal and liver mass during transition were apparently a consequence of changes in DM intake and nutrient supply and not initiation of lactation per se.

The adrenal secretory serine protease AsP is a short secretory isoform of the transmembrane airway trypsin-like protease

To further elucidate the role of proteases capable of cleaving N-terminal proopiomelanocortin (N-POMC)-derived peptides, we have cloned two cDNAs encoding isoforms of the airway trypsin-like protease (AT) from mouse (MAT) and rat ( RAT), respectively. The open reading frames comprise 417 amino acids (aa) and 279 aa. The mouse AT gene was located at chromosome 5E1 and contains 10 exons. The longer isoform, which we designated MAT1 and RAT1, has a simple type II transmembrane protein structure, consisting of a short cytoplasmic domain, a transmembrane domain, a SEA (63-kDa sea urchin sperm protein, enteropeptidase, agrin) module, and a serine protease domain. The human homolog of MAT1 and RAT1 is the human AT ( HAT). The shorter isoform, designated MAT2 and RAT2, which contains an alternative N terminus, was formerly described in the rat as adrenal secretory serine protease (AsP) and has been shown to be involved in the processing of N-POMC-derived peptides. In contrast to the long isoform, neither MAT2 and RAT2 ( AsP) contain a transmembrane domain nor a SEA domain but an N-terminal signal peptide to direct the enzyme to the secretory pathway. The C terminus, covering the catalytic triad, is identical in both isoforms. Immunohistochemically, MAT/RAT was predominantly expressed in tissues of the upper gastrointestinal and the respiratory tract - but also in the adrenal gland. Moreover, isoform-specific RT-PCR and quantitative PCR analysis revealed a complex expression pattern of the two isoforms with differences between mice and rats. These findings indicate a multifunctional role of these proteases beyond adrenal proliferation.

Fecal microbiota in patients receiving enteral feeding are highly variable and may be altered in those who develop diarrhea

Background: The pathogenesis of diarrhea in patients receiving enteral feeding includes colonic water secretion, antibiotic prescription, and enteropathogenic colonization, each of which involves an interaction with the gastrointestinal microbiota. Objective: The objective was to investigate temporal changes in the concentrations of fecal microbiota and short-chain fatty acids (SCFAs) in patients starting 14-d of enteral feeding and to compare these changes between patients who do and do not develop diarrhea. Design: Twenty patients starting exclusive nasogastric enteral feeding were monitored for 14 d. Fecal samples were collected at the start, middle, and end of this period and were analyzed for major bacterial groups by using culture independent fluorescence in situ hybridization and for SCFAs by using gas-liquid chromatography. Results: Although no significant changes in fecal microbiota or SCFAs were observed during enteral feeding, stark alterations occurred within individual patients. Ten patients (50%) developed diarrhea, and these patients had significantly higher concentrations of clostridia (P = 0.026) and lower concentrations (P = 0.069) and proportions (P = 0.029) of bifidobacteria. Patients with and without diarrhea had differences in the proportion of bifidobacteria (median: 0.4% and 3.7%; interquartile range: 0.8 compared with 4.3; P = 0.035) and clostridia (median: 10.4% and 3.7%; interquartile range: 14.7 compared with 7.0; P = 0.063), respectively, even at the start of enteral feeding. Patients who developed diarrhea had higher concentrations of total fecal SCFAs (P = 0.044), acetate (P = 0.029), and butyrate (P = 0.055). Conclusion: Intestinal dysbiosis occurs in patients who develop diarrhea during enteral feeding and may be involved in its pathogenesis. Am J Clin Nutr 2009; 89: 240-7.

Prebiotic interventions for the improvement of gut health

The increasing awareness of the role that the colonic microflora plays in maintaining host health within the gastrointestinal tract and systemically through the absorption of metabolites, has attracted a lot of interest, within the nutritional sciences, in developing dietary tools for controlling the colonic microflora. Among those dietary tools, prebiotics aim to improve health by stimulating numbers and/or activities of the beneficial bacteria in the gut, mainly bifidobacteria and lactobacilli. The ability of incorporating prebiotics in various food processes together with recent developments in understanding how prebiotics are metabolised by health promoting bacteria, allow us to specifically aim such dietary interventions towards selected population groups, such as infants and elderly, and disease states, such as colon cancer and irritable bowel disease.

Modulation of the fecal microflora profile and immune function by a novel trans-galactooligosaccharide mixture (B-GOS) in healthy elderly volunteers

Background: Aging is associated with reduced numbers of beneficial colonic bifidobacteria and impaired immunity. Galactooligosaccharides (GOSs) stimulate the growth of bifidobacteria in younger adults, but little is known about their effects in the elderly and their immunomodulatory capacity. Objective: We assessed the effect of a prebiotic GOS mixture (B-GOS) on immune function and fecal microflora composition in healthy elderly subjects. Design: In a double-blind, placebo-controlled, crossover study, 44 elderly subjects were randomly assigned to receive either a placebo or the B-GOS treatment (5.5 g/d). Subjects consumed the treatments for 10 wk, and then went through a 4-wk washout period, before switching to the other treatment for the final 10 wk. Blood and fecal samples were collected at the beginning, middle (5 wk), and end of the test period. Predominant bacterial groups were quantified, and phagocytosis, natural killer (NK) cell activity, cytokine production, plasma cholesterol, and HDL cholesterol were measured. Results: B-GOS significantly increased the numbers of beneficial bacteria, especially bifidobacteria, at the expense of less beneficial groups compared with the baseline and placebo. Significant increases in phagocytosis, NK cell activity, and the production of antiinflammatory cytokine interleukin-10 (IL-10) and significant reduction in the production of proinflammatory cytokines (IL-6, IL-1 beta , and tumor necrosis factor-alpha) were also observed. B-GOS exerted no effects on total cholesterol or HDL-cholesterol production, however. Conclusions: B-GOS administration to healthy elderly persons resulted in positive effects on both the microflora composition and the immune response. Therefore, B-GOS may be a useful dietary candidate for the enhancement of gastrointestinal health and immune function in elderly persons. Am J Clin Nutr 2008; 88: 1438-46.

Modulation of anti-pathogenic activity in canine-derived Lactobacillus species by carbohydrate growth substrate

Aims: To investigate the effect of various carbon sources on the production of extracellular antagonistic compounds against two Escherichia coli strains and Salmonella enterica serotype Typhimurium by three canine-derived lactobacilli strains. Methods and Materials: Cell-free preparations, pH neutralized, were used in antibiotic disc experiments as an initial screening. The bacteria/carbohydrate combinations that showed inhibition of the growth of those pathogens, were further investigated in batch co-culture experiments. The cell-free supernatants of the cultures, that decreased the population number of the pathogens in the co-culture experiments to log CFU ml(-1) less than or equal to 4, were tested for inhibition of the pathogens in pure cultures at neutral and acidic pH. Conclusions: The results showed that the substrate seems to affect the production of antimicrobial compounds and this effect could not just be ascribed to the ability of the bacteria to grow in the various carbon sources. L. mucosae, L. acidophilus and L. reuteri, when grown in sugar mixtures consisting of alpha-glucosides (Degree of Polymerization (DP) 1-4) could produce antimicrobial compounds active against all three pathogens in vitro. This effect could not be attributed to a single ingredient of those sugar mixtures and was synergistic. This inhibition had a dose-response characteristic and was more active at acidic pH. Significance and Impact of the Study: Knowledge of the effect that the carbon source has on the production of antimicrobial compounds by gut-associated lactobacilli allows the rational design of prebiotic/probiotic combinations to combat gastrointestinal pathogens.

Modulation of the human gut microflora towards improved health using prebiotics: assessment of efficacy

There is increasing awareness that the human gut microflora plays a critical role in maintaining host health, both within the gastrointestinal tract and, through the absorption of metabolites, systemically. An 'optimal' gut microflora establishes an efficient barrier to the invasion and colonisation of the gut by pathogenic bacteria, produces a range of metabolic substrates which in turn are utilized by the host (e.g. vitamins and short chain fatty acids) and stimulates the immune system in a non-inflammatory manner. Although little is known about the individual species of bacteria responsible for these beneficial activities, it is generally accepted that the bifidobacteria and lactobacilli constitute important components of the beneficial gut microflora. A number of diet-based microflora management tools have been developed and refined over recent decades including probiotic, prebiotic and synbiotic approaches. Each aims to stimulate numbers and/or activities of the bifidobacteria and lactobacilli within the gut microflora. The aim of this article is to examine how prebiotics are being applied to the improvement of human health and to review the scientific evidence supporting their use.

Using probiotics and prebiotics to improve gut health

Recent molecular-based investigations have confirmed the species diversity and metabolic complexity of the human gut microbiota. It is also increasingly clear that the human gut microbiota plays a crucial role in host health, both as a source of infection and environmental insult and, conversely, in protection against disease and maintenance of gut function. Although little is known about the health impact of the dominant groups of gut bacteria it is generally accepted that bifidobacteria and lactobacilli are important components of what might be termed the beneficial gut microbiota. The microbiota management tools of probiotics, prebiotics and synbiotics have been developed and, indeed, commercialized over the past few decades with the expressed purpose of increasing numbers of bifidobacteria and/or lactobacilli within the gastrointestinal tract.

Inulin-type fructans in healthy aging

Worldwide, the population is aging, with estimates of 1 billion people aged 60 y or over within the next 20 y. With aging comes a reduction in overall health and increased morbidity and mortality due to infectious disease. Mortality due to gastrointestinal infections is up to 400 times higher in the elderly compared with younger adults. Recent studies have shown that the gut microbiota changes in old age, with an increased number of bacterial groups represented in the predominant elderly gut microbiota. This change in species "evenness" coincides with parallel changes in immune function, diet, and lifestyle and may contribute to disease susceptibility and severity in old age. The intestinal microbiota may thus be identified as an important target for improving health through reduced disease risk. Here, the application of prebiotics, especially the inulin-type fructans, and synbiotics (prebiotics combined with efficacious probiotic strains) will be discussed in terms of microbiota modulation and impact on disease risk in the aged population. Recent human intervention studies have confirmed the microbiota modulatory capability of the inulin-type fructans in the elderly and there is some evidence for reduced risk of disease. However, there is a need for more and larger human intervention studies to determine the efficacy of prebiotics in the elderly, particularly studies that take advantage of recent high resolution analytical methodologies like metabonomics, to shed light on possible prebiotic mechanisms of action.

Probiotics and prebiotics in female health

Functional foods such as probiotics, prebiotics and nutraceuticals are of extreme interest to researchers. There is growing evidence that these food ingredients may improve and in some cases treat certain conditions that are implicated in women's health. The use of probiotics (live, beneficial bacteria) in improving gastrointestinal and non-gastrointestinal tract conditions such as irritable bowel syndrome, candidiasis and other female urogenital tract conditions are reviewed. Emphasis is also given to the importance of prebiotics (non-digestible food ingredients) in osteoporosis management and alleviation of menopausal symptoms and reducing the onset of cancer.

Sialyloligosaccharides inhibit cholera toxin binding to the GM1 receptor

It is recognised that cholera toxin (Ctx) is a significant cause of gastrointestinal disease globally, particularly in developing countries where access to uncontaminated drinking water is at a premium. Ctx vaccines are prohibitively expensive and only give short-term protection. Consequently, there is scope for the development of alternative control strategies or prophylactics. This may include the use of oligosaccharides as functional mimics for the cell-surface toxin receptor (GM I). Furthermore, the sialic acid component of epithelial receptors has already been shown to contribute significantly to the adhesion and pathogenesis of Ctx. Here, we demonstrate the total inhibition of Ctx using GM1-competitive ELISA with 25 mg mL(-1) of a commercial preparation of sialyloligosaccharides (SOS). The IC50 value was calculated as 5.21 mg mL(-1). One-hundred percent inhibition was also observed at all concentrations of Ctx-HRP tested with 500 ng mL(-1) GM1-OS. Whilst SOS has much lower affinity for Ctx than GM1-OS, the commercial preparation is impure containing only 33.6% carbohydrate; however, the biantennary nature of SOS appears to give a significant increase in potency over constituent monosaccahride residues. It is proposed that SOS could be used as a conventional food additive, such as in emulsifiers, stabilisers or sweeteners, and are classified as nondigestible oligosaccharides that pass into the small intestine, which is the site of Ctx pathogenesis. (C) 2008 Elsevier Ltd. All rights reserved.