Motor physiotherapy in the treatment of preterm infants with metabolic bone disease

OBJECTIVE: To review the role of motor physiotherapy in the treatment of preterm infants at risk of developing metabolic bone disease. DATA SOURCES: This is a review of articles published between 1986 and 2009, using the following key-words: premature infant physiologic calcification, physiotherapy techniques, metabolic bone diseases and the respective Portuguese-language descriptors. Twenty nine scientific articles were selected in the PubMed and ISI Web databases, along with one chapter of a Brazilian book. DATA SYNTHESIS: Metabolic bone diseases are a set of conditions related to abnormalities in the physiologic calcification process. They lead to problems going from structural frailness to fracture development. Routine application of passive joint mobilization exercises, massage and positioning exercises correlate with weight gain and increasing bone mineral content and density. CONCLUSIONS: Implementation of motor physiotherapy exercises could provide stability or stimulation for bone formation and may consequently avoid or minimize the complications resulting from metabolic bone disease of prematurity.OBJETIVO: Revisar o papel da fisioterapia motora no prematuro com risco de desenvolver doença metabólica óssea. FONTES DE DADOS: Trata-se de uma revisão de literatura publicada entre 1986 e 2009, utilizando as seguintes palavras-chave: prematuro, calcificação fisiológica, modalidades de fisioterapia, doenças ósseas metabólicas e os respectivos descritores no idioma inglês. Foram selecionados 29 artigos científicos, via PubMed e ISI Web, além de um capítulo de livro nacional. SÍNTESE DOS DADOS: As doenças ósseas metabólicas compreendem um conjunto de condições relacionadas a alterações no processo de calcificação fisiológica, levando desde à fragilidade estrutural até ao desenvolvimento de fraturas. A aplicação rotineira de exercícios de mobilização passiva articular, massagem e posicionamento está relacionada ao ganho ponderal, ao aumento na densidade e no conteúdo mineral ósseo. CONCLUSÕES: A implementação de exercícios de fisioterapia motora parece proporcionar estabilidade ou estímulo para a formação óssea, podendo, consequentemente, prevenir e/ou minimizar as complicações decorrentes da doença metabólica óssea.UNIFESP Departamento de PediatriaHospital das Clínicas Luzia de Pinho MeloUNIFESP, Depto. de PediatriaSciEL

La Influencia de la familia o tutores en el rendimiento escolar de jóvenes en situación de vulnerabilidad: un estudio de casos de alumnos del cuarto medio A y D del Liceo Alberto Hurtado de San Francisco de Mostazal

Tesis (Psicopedagogo, Licenciado en Educación)El presente Seminario de Grado pretende comprender que la vulnerabilidad tiene relación con complejidades sociales, entendiendo por una parte, que existen factores de orden más estructural en su origen, que no radican en los sujetos, y que el asistencialismo promovido por el, que se limita a satisfacer las necesidades básicas para la supervivencia, no incide en la superación de los factores que causan la vulnerabilidad. Por ende, aunque el concepto de vulnerabilidad pasa a ser central en las políticas públicas no favorece al desarrollo humano. Específicamente, se define vulnerabilidad como "Condición dinámica que resulta de la interacción de una multiplicidad de factores de riesgo y protectores, que ocurren en el ciclo vital de un sujeto y que se manifiestan en conductas o hechos de mayor o menor riesgo social, económico, psicológico, cultural, ambiental y/o biológico, produciendo una desventaja comparativa entre sujetos, familias y/o comunidades" (JUNAEB, 2005, p. 14). De este modo, una mayor vulnerabilidad implica mayor riesgo. La presente investigación se enmarca dentro del Paradigma Post-Positivista, ya que se caracteriza por tener un rol ontológico, es decir, la realidad está sujeta al investigador pues permite comprender el contexto donde se encuentran los jóvenes y así tener una mirada empíricamente fundada de influencia de la familia en el rendimiento académico de los jóvenes con un alto nivel de vulnerabilidad, a su vez esta investigación recopila datos en un solo momento único, por ende, este estudio es de tipo no experimental transeccional, ya que su propósito es describir variables y analizar su incidencia e interrelación en un momento dado. El tipo de investigación es descriptivo, ya que busca especificar propiedades importantes de personas, grupos o comunidades que se ha sometido a análisis. Además intenta demostrar que el supuesto que tiene relación con el rendimiento escolar, no solo depende de los factores personales, sino que también a los factores contextuales familiares, difíciles de describir y que las políticas públicas actuales al no tomar en cuenta esta variable no ha sido efectiva. Para esta investigación se ha considerado como población de referencia a jóvenes que asisten al Liceo Alberto Hurtado, siendo la unidad de análisis los alumnos de cuarto año medio, en este caso cuarto año A y cuarto año D, la cantidad de jóvenes que serán entrevistados son 4 por caso. A través de la información obtenida y graficada, los resultados en cuanto al ámbito motivacional, establecen que los estudiantes desean en su mayoría aprender e investigar nuevos conocimientos, que desean comprender y entender lo que se les enseña, sin embargo, se observa una tendencia opuesta en especial el grupo de varones lo que indicaría desmotivación o falta de interés de estos por experimentar y conocer nuevas realidades, de acuerdo a la información de responsabilidad de los alumnos frente a sus estudios se observan los porcentajes más altos de desinterés o indiferencia, lo cual podría indicar que los alumnos no ven sus estudios como un factor de importancia o que sea relevante para ellos, finalmente el ámbito del apoyo familiar entrega la información necesaria para poder mencionar de que la percepción de los estudiantes respecto al apoyo que reciben en su hogar de familiares o sus tutores es positivo, osea que si cuentan en la mayoría de los casos con este factor de apoyo. No es el objetivo de este seminario dar una respuesta definitiva a la problemática expuesta, sino iniciar una reflexión a partir de experiencias y aportes teóricos que abordan una perspectiva similar a la orientación de esta investigación

Rol de la educadora de párvulos en el desarrollo de la autorregulación emocional en niños y niñas de nivel transición II

Tesis (Educación Parvularia)El rol de la Educadora de Párvulos es fundamental en el desarrollo de la autorregulación emocional de niños y niñas, debido a que las Educadoras de Párvulos son las encargadas de planificar y elaborar estrategias que ayuden y beneficien a los párvulos a ser capaces de regular sus propias emociones. El objetivo principal de la investigación fue analizar el rol de la educadora de párvulos en el desarrollo de la autorregulación de niños y niñas de nivel transición II. Para lograr este objetivo, se aplicó un estudio exploratorio basado en un enfoque cualitativo de investigación, aplicando un cuestionario semiestructurado a cuatro Educadoras de Párvulos que ejercen en el respectivo nivel mencionado anteriormente, de diferentes ciudades de Chile. De los resultados arrojados en el cuestionario, se obtuvo que las Educadoras de Párvulos concuerdan sobre la importancia de enseñar a los párvulos el poder de autorregular sus distintas emociones, por lo tanto, consideraron primordial el generar estrategias metodológicas innovadoras y lúdicas que les permita a los niños y niñas poder concentrarse en sus emociones, lograr expresarlas y que los escuchen. Uno de los factores que consideraron importante las Educadoras de Párvulos entrevistadas es el crear un ambiente de aprendizaje propicio, en donde los párvulos se sientan cómodos, un ambiente que les facilite cumplir el objetivo primordial de autorregular sus emociones, debido a como se evidenció en la investigación no es una tarea sencilla.The role of the kindergarten educators is crucial in the development of children's emotional self-regulation because these educators must plan and elaborate strategies that help and benefit infants to be able to regulate their own emotions. The main objective of the research was to analyze the role of a nursery teacher in the development of emotional self-regulation of children from the Transition II level. To achieve this aim, an exploratory study was applied under an investigative qualitative approach, using a semi-structured questionnaire to four nursery teachers that work in the already mentioned level in different cities in Chile. From the results collected in the questionnaire, it was obtained that pre-school teachers agree on the importance of teaching infants the power to self-regulate their different emotions. Therefore, they considered that it is essential to generate fun and innovative methodological strategies that allow kids to focus on their emotions, being able to express them and make others listen to them. One of the factors that pre-school teachers considered important is to create a favorable learning environment, where children feel comfortable. An environment that enables them to achieve their main goal in self-regulating their emotions and according to how it was demonstrated in the research, is not an easy task

Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales

OBJECTIVE: To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. METHODS: Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fisher's exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. RESULTS: Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor (-10.67; 95%CI:-19.74 to -1.59) and adaptive-behavior scores (-21.52; 95%CI: -35.60 to -7.44). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). CONCLUSIONS: Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.OBJETIVO: Avaliar a prevalência de atraso e fatores associados aos escores de desenvolvimento em crianças nascidas prematuras. MÉTODOS: Estudo transversal para avaliar o desenvolvimento por escalas Bayley III, incluindo-se prematuros de muito baixo peso de 18 a 24 meses de idade corrigida, acompanhados no Ambulatório de Prematuros da instituição. Excluíram-se: malformação congênita, síndrome genética, infecção congênita sintomática ao nascimento, surdez e cegueira. As variáveis numéricas foram comparadas por teste t de Student ou Mann-Whitney, e as categóricas, por qui-quadrado ou teste exato de Fisher. Para análise dos fatores associados aos escores de desenvolvimento, utilizou-se a regressão linear, considerando-se significante p < 0,05. RESULTADOS: Das 58 crianças avaliadas, quatro (6,9%) apresentaram alteração cognitiva; quatro (6,9%), motora; 17 (29,3%), de linguagem; 16 (27,6%), socioemocional; e 22 (37,9%), de comportamento adaptativo. À regressão linear múltipla, os fatores classe socioeconômica CDE (-13,27; IC95% -21,23 a -5,31) e dependência de oxigênio com 36 semanas de idade corrigida (-8,75; IC95% -17,10 a -0,39) diminuíram o escore cognitivo. A leucomalácia periventricular diminuiu o escore cognitivo (-15,21; IC95% -27,61 a -2,81), motor (-10,67; IC95% -19,74 a -1,59) e de comportamento adaptativo (-21,52; IC95% -35,60 a -7,44). O sexo feminino se associou ao maior escore motor (10,67; IC95% 2,77-12,97), de linguagem (15,74; IC95% 7,39-24,09) e socioemocional (10,27; IC95% 1,08-19,46). CONCLUSÕES: Prematuros de muito baixo peso apresentaram com maior frequência alterações na linguagem, comportamento adaptativo e socioemocional. As variáveis classe socioeconômica CDE, leucomalácia periventricular, displasia broncopulmonar e sexo masculino contribuíram para reduzir os escores de desenvolvimento.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

The effect of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea and uncontrolled hypertension : study design and challenges during the COVID-19 pandemic

OBJECTIVES: To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS: MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and >= 80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index >= 15 events/ hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. ClinicalTrials.gov: NCT02270658. RESULTS: The first 100 patients are predominantly males (n=69), age: 52±10 years, body mass index: 32.7±3.9 kg/m2 with frequent co-morbidities. CONCLUSIONS: The MORPHEOS trial has a unique study design including a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Assessment of development in preterm infants with birth weight between 1500 and 1999 grams at 18-24 months of corrected age, by Bayley Scales III

Objetivos: Avaliar o desenvolvimento de prematuros com peso ao nascer de 1500 a 1999g, entre 18 e 24 meses de idade corrigida, por meio da Bayley III, determinando-se a prevalencia de alteracao nos escores de desenvolvimento e identificar os fatores associados ao menor escore de desenvolvimento. Metodos: Estudo transversal realizado no periodo de janeiro de 2009 a outubro de 2011, apos aprovacao do Comite de Etica e Pesquisas da Escola Paulista de Medicina - Universidade Federal de São Paulo e assinatura do Termo de Consentimento Livre e Esclarecido pelos pais. Foram incluidas criancas com idade corrigida de 18 a 24 meses, nascidas com idade gestacional <37 semanas e peso ao nascer de 1500 a 1999 gramas, acompanhadas no Ambulatorio de Prematuros da instituicao. Foram excluidos os casos de malformacoes, sindromes geneticas e infeccoes congenitas sintomaticas. Realizou-se a avaliacao do desenvolvimento cognitivo, linguagem, motor, socioemocional e de comportamento adaptativo (adaptativo geral, conceitual, social e pratico) por meio das Escalas Bayley III e coleta de dados demograficos e clinicos do prontuario da crianca. As variaveis categoricas foram comparadas por 2 ou teste exato de Fisher e as numericas por teste t ou Mann-Whitney. Os fatores associados aos escores de desenvolvimento foram analisados por regressao linear e os associados ao atraso no desenvolvimento (escore <85), por regressao logistica. Considerou-se significante, p<0,05. Resultados: Avaliaram-se 100 criancas, com idade corrigida de 19,9±2,0 meses, peso ao nascer de 1743±142g e idade gestacional de 33,2±1,7 semanas. A porcentagem e o IC95% de criancas com atraso no desenvolvimento cognitivo foram (2,0%; 0,6 a 7,0%), linguagem (5,0%; 2,2 a 11,2%), motor (3,0%; 1,0 a 8,5%), socioemocional (13,0%; 7,8 a 20,1%), adaptativo geral (26,0%; 18,4 a 35,4%), conceitual (17,0%; 10,9 a 25,6%), social (46,0%; 36,6 a 55,7%) e pratico (21,0%; 14,2 a 30,0%). A regressao linear multipla, o escore de desenvolvimento cognitivo diminuiu -5,909 (IC 95%: -11,697 a -0,121) pontos na crianca que recebeu ventilacao mecanica. O desenvolvimento de linguagem diminuiu -5,243 (IC 95%: -10,201 a -0,285) pontos na mae nao branca e -0,178 (IC 95%: -0,311 a -0,045) pontos por dia de internacao na unidade neonatal. O desenvolvimento motor diminuiu -6,269 (IC 95%: -12,451 a -0,088) pontos no parto cesareo e diminuiu 9,868 (IC 95%: -16,413 a -3,323) pontos na hemorragia peri-intraventricular. O desenvolvimento socioemocional diminuiu -10,942 (IC 95%: -19,240 a -2,644) pontos na escolaridade <9 anos e -11,371 (IC 95%: -20,835 a -1,906) pontos na crianca com z-escore de altura/idade <-2. O desenvolvimento adaptativo geral diminuiu -7,853 (IC 95%: -14,943 a -0,763) pontos na classe C/D; diminuiu -6,868 (IC 95%: -11,861 a -1,874) pontos no sexo masculino e diminuiu -7,174 (IC 95%: -13,212 a -1,136) pontos na hemorragia peri-intraventricular. O desenvolvimento conceitual aumentou 7,777 (IC 95%: 0,604 a 14,951) pontos na mae sem parceiro fixo e diminuiu -6,201 (IC 95%: -12,116 a -0,287) pontos se z-escore de altura/idade <-2. O desenvolvimento social aumentou 15,118 (IC 95%: 6,282 a 23,959) pontos na mae sem parceiro fixo; diminuiu -10,614 (IC 95%: -18,258 a -2,970) pontos na classe C/D; -8,228 (IC 95%: -14,942 a -2,970) pontos na presenca de hemorragia peri-intraventricular; -10,647 (IC 95%: -17,173 a -4,120) pontos se a crianca frequentava creche e -6,673 (IC 95%: -13,332 a -0,015) pontos se z-escore altura/idade <-2. O desenvolvimento pratico diminuiu -5,837 (IC 95%: -11,064 a -0,610) no sexo masculino. Ja na regressao logistica multipla, a chance de atraso de desenvolvimento socioemocional foi 5,000 (IC 95%: 1,415 a 17,668) vezes maior na escolaridade <9 anos. A chance de atraso de desenvolvimento social foi 3,344 (IC 95%: 1,212 a 9,221) vezes maior na classe C/D; 4,323 (IC 95%: 1,171 a 15,964) vezes maior no parto cesareo e 3,017 (IC95%: 1,059 a 8,597) vezes maior na hemorragia peri-intraventricular. A chance de atraso no desenvolvimento pratico foi 4,885 (IC 95%: 1,6268 a 14,655) vezes maior no pequeno para idade gestacionalBV UNIFESP: Teses e dissertaçõe

Medidas socioeducativas com seus dispositivos disciplinares: o que, de fato, está em jogo nesse sistema?

We present a critical reflection on the subject of socio-educational measures present in the Child and Adolescent Statute (ECA). To achieve this goal, we conduct a literature online search on Scielo and the national scientific production system Pepsic, in the field of psychology, with reference to the theme of the adolescent author of offensive Act during the period from 2000 to 2012. Found 59 items on the subject of adolescents and the reading of these allowed us to organize them into three areas: (1) practical-experencial; (2) cultural theorist; (3) and political-institutional. The focus of our paper is to present and discuss the third analytical research plan, namely, the articles that feature the dimension of reflection in political and institutional aspects involved in the socio-educational measures. It was possible to conclude that, despite the innovative nature of the ECA, sometimes, public policy can put across adolescents authors of offensive Act as society's waste and thus operate an exclusion and enclosure.Nous présentons une réflexion critique sur le thème des mesures sociales et éducatives présentes dans Statut des enfants et des adolescents ( ECA ). Pour atteindre cet objectif, une recherche documentaire a été effectuée dans les systèmes Pepsic SciELO et sur la production scientifique nationale dans le domaine de la psychologie à propos de l'adolescent qui commet une infraction. La recherche sur les articles publiés au cours de la période comprise entre les années 2000 et 2012 a trouvé 59 textes sur le thème de l' adolescent qui commet une infraction, et sa lecture nous a permis de les organiser en trois niveaux: ( 1 ) l'expérience pratique - ; ( 2 ) la théorie socioculturelle ; ( 3 ) et le politico-institutionnel. Notre travail a pour but présenter et discuter le troisième niveau d'analyse de la recherche, à savoir les articles qui ont la dimension de la réflexion sur les aspects politiques et institutionnels impliqués dans les mesures éducatives. Il a conclu que, malgré le caractère novateur de la ECA, les politiques publiques parfois peuvent mettre les adolescents qui commetent une infraction en tant que rejet de la société et donc sujet d'une exclusion et d'une clôture.Apresentamos uma reflexão crítica sobre o tema das medidas socioeducativas presentes no Estatuto da Criança e do Adolescente (ECA). Para concretizar este objetivo, foi realizada uma pesquisa bibliográfica nos sistemas Scielo e Pepsic sobre a produção científica nacional, no campo da psicologia, sobre o adolescente autor de ato infracional publicada durante o período entre os anos de 2000 e 2012. Foram encontrados 59 artigos sobre o tema do adolescente autor de ato infracional, e a leitura destes nos permitiu organizá-los em três planos: (1) práticoexperencial; (2) teórico sociocultural; (3) e político-institucional. O foco de nosso artigo é apresentar e discutir o terceiro plano analítico da investigação, a saber, os artigos que apresentam a dimensão de reflexão dos aspectos político-institucionais implicados nas medidas socioeducativas. Foi possível concluir que, apesar do caráter inovador do ECA, por vezes, as políticas públicas podem colocar os adolescentes autores de ato infracional como dejeto da sociedade e, assim, operar por sua exclusão, adaptação e enclausuramento.Presentamos una reflexión crítica sobre el tema de las medidas socio-educativas presentes en el Estatuto de Niños y Adolescentes (ECA). Para lograr este objetivo, realizamos una búsqueda bibliográfica en el sistema Scielo y Pepsic sobre la producción científica nacional, en el campo de la psicología, que se refiere al tema del adolescente autor del acto infraccional en el período 2000-2012. Encontrados 59 artículos sobre el tema del adolescente y su lectura nos permitió organizarlos en tres planos: (1) práctico-experiencial; (2) teórico sociocultural; (3) y político-institucional. El enfoque de nuestro artículo es presentar y discutir el tercer plano analítico de investigación, a saber, los artículos que cuentan con la dimensión de la reflexión de los aspectos político-institucionales involucrados en las medidas socio-educativas. Fue posible concluir que, pese al carácter innovador del ECA, a veces, las políticas públicas pueden poner a los adolescentes autores del acto infraccional como desechos de la sociedad y así operar exclusión y enclaustramiento

Novel Devices for Transporting Protein Crystals to the Synchrotron Facilities and Thermal Protection of Protein Crystals

In this article, we use novel and non-conventional devices, based on polyolefins that help to increase the thermal protection of protein crystals in their crystallization conditions for crystallographic applications. The present contribution deals with the application of some ad hoc devices designed for transporting protein crystals to the synchrotron facilities. These new devices help transporting proteins without cryo-cooling them, therefore replacing the conventional dry Dewars. We crystallized four model proteins, using the classic sitting-drop vapor diffusion crystallization setups. The model proteins lysozyme, glucose isomerase, xylanase, and ferritin were used to obtain suitable crystals for high-resolution X-ray crystallographic research. Additionally, we evaluated the crystallization of apo-transferrin, which is involved in neurodegenerative diseases. As apo-transferrin is extremely sensitive to the changes in the crystallization temperature, we used it as a thermal sensor to prove the efficiency of these thermal protection devices when transporting proteins to the synchrotron facilities