Terapia ocupacional, dança e expressividade: favorecendo espaços de encontro para adolescentes abrigado/ Occupational therapy, dance and expressivity: favoring encounter spaces for adolescents covered

Introdução: As atividades expressivas, como dança e pintura, são recurso potenciais utilizados pelo terapeuta ocupacional para alcançar objetivos diversos, transformando as expressões do sujeito e reorganizando o sentido de sua existência. Objetivo: Descrever e discutir a intervenção do terapeuta ocupacional utilizando a dança e a pintura como recurso terapêutico, no contexto da institucionalização com grupos de adolescentes. Além de avaliar a possível melhora da autoestima e expressão dos adolescentes em situação de abrigo após os grupos de terapia ocupacional e descrever o significado dos grupos de terapia ocupacional para eles. Métodos: trata-se de uma pesquisa qualitativa, descritiva. A coleta dos dados foi realizada por meio de dez encontros, na qual utilizou-se da dança e atividades com pintura,  por um período de três meses. Participaram da pesquisa seis sujeitos (três do sexo masculino e três do sexo feminino). Resultados: Foi possível observar uma mudança no comportamento dos participantes pois, nos primeiros encontros sentiam-se inibidos e ao longo das atividades conseguiram se expressar melhor por meio da dança e das pinturas. Assim, foi visto que é de grande importância possibilitar ao sujeito em situação de abrigo a expressão dos seus sentimentos, pois, muitas vezes sua expressão e autoestima são prejudicadas por todo o processo que o sujeito vivenciou e continua vivenciando. Conclusão: O terapeuta ocupacional com seu olhar humanista, consegue contribuir para que os sujeitos se expressem melhor, trazendo seus desejos e medos, e facilitando as relações interpessoais entre os adolescentes através das atividades expressivas

Terapia ocupacional, dança, pintura e expressividade: favorecendo espaços de encontro para adolescentes em abrigo institucional / Occupational therapy, dance, paint and expressivity: favoring encounter spaces for adolescentes in institutional care

Introdução: As atividades expressivas, como dança e pintura, são recursos potenciais utilizados pelo terapeuta ocupacional para alcançar objetivos diversos, transformando as expressões do sujeito e reorganizando o sentido de sua existência. Objetivos: tem como objetivo geral discutir a intervenção do terapeuta ocupacional utilizando a dança e a pintura como recursos terapêuticos, no contexto da institucionalização com grupos de adolescentes; e objetivos específicos: descrever autoestima e expressão dos adolescentes em situação de abrigo após os grupos de terapia ocupacional e descrever o significado dos grupos de terapia ocupacional para eles. Métodos: trata-se de uma pesquisa qualitativa, descritiva e intervencionista, realizada na sede de serviço de acolhimento para adolescentes no município de Lagarto, Sergipe. Foram realizados dez encontros, uma vez por semana, com duração de 2 horas, durante um período de três meses, compostos por atividades de dança e pintura, nos quais foram coletadas informações dos participantes do estudo. Resultados: Seis adolescentes participaram da pesquisa (três do sexo masculino e três do sexo feminino). No decorrer dos encontros foi possível observar mudanças no comportamento dos participantes, ao longo das atividades conseguiram se expressar melhor por meio da dança e das pinturas, visto que na maioria das vezes a expressão e a autoestima são prejudicadas por todo o processo que o adolescente em abrigo institucional vivenciou e continua vivenciando. Conclusão: As intervenções do terapeuta ocupacional podem contribuir para a emancipação dos sentimentos que permitiram os adolescentes em abrigo institucional se expressarem melhor, expondo desejos e medos por intermédio das expressões artísticas propostas, facilitando as relações interpessoais entre os adolescentes através das atividades expressivas

Tonsillotomy by a Fractional Carbon Dioxide Laser: A New Technique in the Treatment of Chronic Tonsillitis: Fractional Carbon Dioxide Laser Controls Chronic Tonsillitis

Introduction: chronic tonsillitis has a global prevalence ranging from 5-12%. Its clinical manifestations, like recurrent acute tonsillitis, tonsils hypertrophy, caseum and halitosis, can lead adult patients to be submitted to palatine tonsillectomy, surgery that has morbidity and the potential risk of complications, including severe bleeding. This article proposes a new therapy for chronic tonsillitis in adult patients using a   fractional carbon dioxide (CO2) laser, a fast, minimally invasive procedure capable of removing the need for the traditional tonsillectomy in many patients.             Objective: to verify the efficacy of tonsillotomy by fractional ablation using the CO2 laser by comparing number of bacterial infections, tonsils hypertrophy, halitosis and caseum; to analyze the benefits, risks and complications of the technique.  Methods: 20 patients were subjected to one session of tonsillotomy by fractional ablation and were followed up on for a year. The control group was formed by the same patients in the pre-procedure period (one year) without treatment. Results: no complications occurred, the procedure was fast (30 seconds), safe and tolerated well without general anesthesia. After one year, there was a total remission of recurrent acute tonsillitis in 95% of the patients, and after six months there was a statistically significant improvement of halitosis and caseum, and tonsils size reduction (p<0,05).  The level of satisfaction average was 10 after three months and 8 after one year. Conclusion: tonsillotomy by fractional ablation using the CO2 laser is a safe, efficient procedure for chronic tonsillitis in adults, which can be incorporated into the daily clinical practice

Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (ageo18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels 450 mg/L (83% vs. 25%, p=0.008) and D-dimer levels 41000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (po0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, po0.001), vasoactive agent use (83% vs. 3%, po0.001), shock (83% vs. 5%, po0.001), cardiac abnormalities (100% vs. 2%, po0.001), and death (67% vs. 3%, po0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, po0.001), aspirin therapy (50% vs. 0%, po0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39- 526.79; po0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia

Novos paradigmas e velhos discursos: analisando processos de adolescentes em conflito com a lei New paradigms and old discourses: analyzing proceedings of adolescents in conflict with the law

Este artigo evidencia análises contidas na dissertação cujo objetivo foi analisar os discursos dos operadores jurídico-sociais em processos judiciais de Varas da Infância e Juventude de duas cidades brasileiras. Os direitos das crianças e adolescentes, a questão social e a análise do discurso configuraram-se como referenciais teóricos e de análise. Resultados evidenciaram discursos de proteção e revelaram também a intenção de punição. A questão social foi ignorada pelos operadores a despeito dos contextos em que ocorreram as infrações.<br>This article presents an analysis of the discourse of the legal and social operators in judicial proceedings of Childhood and Youth Courts of two Brazilian cities. Children and adolescents rights, the social issue and the analysis of the discourse were arranged as the theoretic and analytic references. The results show discourses related to protection as well as punitive purpose. The social issue was ignored by the operators in spite of the situations in which the infractions occurred

História da educação no Brasil: a constituição histórica do campo (1880-1970)

O artigo aborda a constituição do campo da história da educação no Brasil de dois prismas. No primeiro, elabora um histórico da disciplina a partir de três pertencimentos: à tradição historiográfica do Instituto Histórico e Geográfico do Brasil (IHGB); às escolas de formação para o magistério e à produção acadêmica entre os anos 1940 e 1970. No segundo, enfoca os trabalhos realizados nos últimos 20 anos, apontando temas e períodos de interesse e abordagens teóricas mais recorrentes.<br>This article tackles on the structuring of the field of history of education in Brazil through two angles. The first one elaborates on the history of the discipline from three views: the historiographic tradition of the Historical and Geographical Institute of Brazil ( IHGB); the development of teacher's colleges and the academic production from 1940 to 1970. The second one, focus on works done during the last 20 years, pointing out to topics, periods of interest and the most recurrent theoretical approaches

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society