Efeitos do manejo comportamental de incontinência fecal em adolescente

Fecal incontinence, also known as encopresis, is an evacuation disorder that causes losses in the organic and psychosocial development of children and adolescents, which requires attention and care from parents and health professionals. In the broad context of treatment of encopresis, psychotherapy is an important resource, and behavior therapy identified as one of the most promising and effective modalities for the treatment of difficult elimination. This article presents a study about the effects of behavioral management of fecal incontinence in an adolescent attended in school-clinical psychology in the state of São Paulo for 14 months. From the theoretical and technical tools of behavior analysis, behavioral strategies were developed in the context of psychotherapy with the client as well as guidance for the parents, seeking gradual extinction of encopresis. During this process, the client had significant behavioral acquisitions of regular use of the bathroom and proper toilet training, monitored weekly, which enabled the full dissolution of soiling, and the effect was evaluated in follow-up conducted three months after the end of this intervention.A incontinência fecal, também conhecida como encoprese, é um transtorno de evacuação que acarreta prejuízos ao desenvolvimento psicossocial e orgânico da criança e do adolescente, e que demanda atenção e cuidado de pais e profissionais de saúde. No amplo contexto de tratamento da encoprese, a psicoterapia constitui importante recurso, sendo a terapia comportamental apontada como uma das modalidades mais promissoras e eficazes para o tratamento dessa dificuldade de eliminação. Este artigo apresenta o estudo dos efeitos do manejo comportamental de quadro de incontinência fecal em um adolescente de 14 anos, atendido em clínica-escola de Psicologia do interior do Estado de São Paulo durante 14 meses. A partir do referencial teórico da análise do comportamento, foi desenvolvido, em contexto psicoterápico, um conjunto de estratégias comportamentais com o cliente, bem como orientações aos pais, visando à gradativa extinção encoprética. No decorrer desse processo, o cliente apresentou significativas aquisições comportamentais de uso regular do banheiro e adequado controle esfincteriano, monitoradas semanalmente, que possibilitaram a plena extinção das ocorrências de sujidade, sendo avaliado o efeito em follow-up realizado três meses após o encerramento dessa intervenção.La incontinencia fecal, también conocida como encopresis, es un trastorno de evacuación que acarrea perjuicios en el desarrollo psicosocial y orgánico de niños adolescentes, lo que demanda atención y cuidado de padres y profesionales de salud. En el amplio contexto de tratamiento de la encopresis, la psicoterapia se constituye como recurso importante, siendo la Terapia Conductual apuntada como una de las modalidades más promisoras y eficaces para tratamiento de esta dificultad de eliminación. Este artículo presenta el estudio de los efectos del manejo del comportamiento de cuadro de incontinencia fecal en un adolescente de 14 años, atendido en clínica escuela de Psicología del interior del estado de São Paulo durante 14 meses. A partir del referencial teórico del Análisis del Comportamiento, fue desarrollado en contexto psicoterápico un conjunto de estrategias de comportamiento con el cliente, así como orientaciones a los padres, visando a la gradual extinción encoprética. En el transcurso de este proceso, el cliente presentó significativas adquisiciones de comportamiento de uso regular del baño y adecuado control de esfínter, monitoreados semanalmente, que posibilitaron la plena extinción de las ocurrencias de suciedad, siendo evaluado el efecto en follow-up realizado tres meses después del cierre de esta intervención

Sustentabilidade em pequenas propriedades: uma proposta educativa

Sustainability values the biodiversity and diversification of production in the same agricultural area, which allows the optimization of productive space, with lower environmental impacts, adapting to the climatic conditions of the region and the interests of the farmer himself. In this work, we sought to survey the research carried out in Rio Grande do Sul to verify the potential of implementing the diversification of production in small farms. For this purpose, articles were searched in the Dialnet database that discuss the benefits of diversification of production and its potentialities. Finally, a sustainable proposal is presented from the context of the “Freedom in the future” agrarian reform settlement in Santana do Livramento, Rio Grande do Sul. This proposal was elaborated based on the Methodology of Trees, which starts from the identification of causes and consequences of conflicts to plan solutions that are feasible by the community itself.Sustainability values the biodiversity and diversification of production in the same agricultural area, which allows the optimization of productive space, with lower environmental impacts, adapting to the climatic conditions of the region and the interests of the farmer himself. In this work, we sought to survey the research carried out in Rio Grande do Sul to verify the potential of implementing the diversification of production in small farms. For this purpose, articles were searched in the Dialnet database that discuss the benefits of diversification of production and its potentialities. Finally, a sustainable proposal is presented from the context of the “Freedom in the future” agrarian reform settlement in Santana do Livramento, Rio Grande do Sul. This proposal was elaborated based on the Methodology of Trees, which starts from the identification of causes and consequences of conflicts to plan solutions that are feasible by the community itself.A sustentabilidade preza pela biodiversidade e diversificação da produção numa mesma área agrícola, que possibilite a otimização do espaço produtivo, com menores impactos ambientais, adequando-se às condições climáticas da região e aos interesses do próprio agricultor. Neste trabalho, buscou-se fazer um levantamento das pesquisas realizadas no Rio Grande do Sul para verificar potencialidades de implementação da diversificação da produção em pequenas propriedades. Para isso foram pesquisados na base de dados Dialnet artigos que discorrem sobre os benefícios da diversificação das produções e suas potencialidades. Por fim, é apresentada uma proposta sustentável a partir do contexto do assentamento de reforma agrária Liberdade no Futuro em Santana do Livramento, no Rio Grande do Sul. Tal proposta foi elaborada com base na Metodologia das Árvores, a qual parte da identificação de causas e consequências de conflitos para planejar soluções que sejam viabilizadas pela própria comunidade

Aquisição da precisão da fala de sentenças em crianças com implante coclear

Speech accuracy is an indicator for evaluating the language of children with cochlear implant (CI). Verifying the teaching that increases this accuracy and how efficiency measures can be adopted are relevant questions. The current study evaluated the acquisition of speech accuracy, using pictures of scenes as controls. Sentences were employed after equivalence-based instruction. Eight children with CI and who were readers participated in the study. The sentences had the following structure: [subject]-[verb]-[object]. The teaching included selecting pictures and constructing printed sentences, conditionally to dictated sentences. Naming and reading was monitored by multiple probes. Two judges transcribed the participants’ vocalizations and the accuracy was measured by the correspondence with target-phonemic units of sentences. All the participants increased the speech accuracy in response to pictures of scenes after the teaching. Acquisition standards were observed and the accuracy was firstly obtained in the terminal portion, followed by the initial portion and, lastly in the medial portion. These results suggest how and under conditions establish the speech accuracy of the sentences in children with CI.La precisión del habla es un indicador para evaluar el lenguaje de niños con implante coclear (IC). Verificar la enseñanza que aumenta esa precisión, y cómo las medidas de eficiencia pueden ser adoptadas, son cuestiones relevantes. El presente trabajo evaluó la adquisición de la precisión del habla controlada por figuras de escenas, usando oraciones, después de la enseñanza basada en equivalencia. Participaron ocho niños con IC, lectores. Las oraciones tenían [sujeto]-[verbo]-[objeto]. La enseñanza consistió en seleccionar figuras y construir oraciones impresas, condicionalmente a las oraciones dictadas. El nombramiento y la lectura fueron supervisadas por múltiples sondas. Dos jueces transcribieron las vocalizaciones de los participantes y la precisión fue medida por la correspondencia con fonemas objetivo de las oraciones. Todos aumentaron la precisión del habla ante las figuras de escenas después de la enseñanza. Patrones de la adquisición fueron observaron y la precisión se obtuvo primero en la porción terminal, seguida de la inicial y por último en la medial. Estos resultados sugieren cómo y qué condiciones establecen la precisión del habla de las oraciones en los niños con IC.La précision de la parole est un indicateur permettant d’évaluer le langage des enfants porteurs d’implants cochléaires (HF). Vérifiez que l’enseignement qui augmente cette précision et comment les mesures d’efficacité peuvent être adoptées sont des questions pertinentes. Le présent travail a évalué l’acquisition d’une précision de la parole contrôlée par des figures de la scène, à l’aide de phrases, après un enseignement basé sur l’équivalence. Huit enfants avec IC et lecteurs ont participé. Les phrases avaient [sujet] - [verbe] - [objet]. L’enseignement consistait à sélectionner des figures et à construire des phrases imprimées, conditionnellement aux phrases dictées. Le rendez-vous et la lecture ont été surveillés par plusieurs sondes. Deux juges ont transcrit les vocalisations des participants et la précision a été mesurée par correspondance avec les phonèmes visés par les phrases. Tous ont augmenté la précision de la parole avant les figures de scènes après l’enseignement et des schémas ont été observés dans lesquels la précision était obtenue d’abord dans la partie terminale, suivie de la première et enfin de la médiale. Ces résultats suggèrent comment et quelles conditions établissent le discours précis des phrases chez les enfants atteints d’insuffisance cardiaque.A precisão da fala é um indicador para avaliar linguagem de crianças com implante coclear (IC). Verificar o ensino que aumenta essa precisão, e como medidas de eficiência podem ser adotadas são questões relevantes. O presente trabalho avaliou a aquisição da precisão da fala controlada por figuras de cenas, usando sentenças, após o ensino baseado em equivalência. Participaram oito crianças com IC e leitoras. As sentenças tinham [sujeito]-[verbo]-[objeto]. O ensino consistiu em selecionar figuras e construir sentenças impressas, condicionalmente às sentenças ditadas. A nomeação e a leitura foram monitoradas por múltiplas sondas. Dois juízes transcreveram as vocalizações dos participantes e a precisão foi medida pela corres-pondência com fonemas-alvo das sentenças. Todos aumentaram a precisão da fala diante das figuras após o ensino. Foram observados padrões de aquisição e a precisão era obtida pri-meiramente na porção terminal, seguida da inicial e por último na medial. Esses resultados sugerem como e quais condições estabelecem a fala precisa de sentenças em crianças com IC

EQUIVALENCE-BASED INSTRUCTION AND SENTENCE PRODUCTION IN CHILDREN WITH COCHLEAR IMPLANT

O ensino baseado em equivalência pode integrar repertórios verbais distintos e promover a precisão da fala em crianças com implante coclear, fato que tem sido observado com palavras e estendido recentemente para sentenças. O presente estudo replicou um estudo prévio e verificou os efeitos do ensino baseado em equivalência sobre a precisão da fala na nomeação de figuras de cenas e a produtividade oral de sentenças (nomear novas figuras relacionadas às sentenças recombinadas), em cinco crianças com implante coclear e leitoras. Os estímulos foram organizados em uma matriz que produziu nove sentenças de três termos, com estrutura sujeito-verbo-objeto (SVO) e o objeto comum; as três sentenças da diagonal da matriz foram ensinadas e as demais testadas. O ensino consistiu em selecionar figuras de cenas (por emparelhamento de acordo com o modelo, MTS) e construir sentenças impressas (por emparelhamento de acordo com o modelo com resposta construída, CRMTS), condicionalmente às sentenças ditadas. Pós-testes de leitura de sentenças impressas e de nomeação de figuras de cenas ocorreram para as sentenças ensinadas e recombinadas. Todos os participantes aprenderam as relações ensinadas, demonstraram relações de equivalência, aumentaram a precisão da fala diante das figuras de cenas e foram capazes de nomear figuras usando as sentenças recombinadas. Nossos resultados replicaram estudos prévios e aumentaram a generalidade dos achados com mais participantes. O aumento na precisão da linguagem oral em crianças com implante coclear e leitoras pode ser obtida por meio de ensino baseado em equivalência e ensino por matrizes.Palavras chave: Ensino baseado em equivalência, matriz, produção oral, sentenças, implante coclear.The equivalence-based instruction can integrate different verbal repertories and promote the speech accuracy in children with cochlear implant, a fact that has been observed with words and, recently extended to sentences. The present study replicated a previous study and verified the effects of equivalence-based instruction on speech accuracy in naming of pictures of scenes and oral productivity of sentences (to name novel pictures related to recombined sentences), in five children with cochlear implant and readers. The stimuli were organized in a matrix that produced nine sentences of three-terms, with subject-verb-object (SVO) structure and common object; the three sentences of matrix diagonal were taught, and others probed. The teaching consisted to select pictures of scenes (by matching-to-sample procedure, MTS) and construct printed sentences (by constructed-response-matching-to-sample, CRMTS), conditionally to dictated sentences. Reading of printed sentences and naming of pictures of scenes posttests occurred for taught and recombined sentences. All participants learned the taught relations, demonstrated equivalence relations, increased the speech accuracy in response to pictures of scenes, and were able to name pictures using recombined sentences. Our results replicated previous studies and increased generality findings with more participants. The increase of accuracy of oral language in children with cochlear implants and readers can be obtained through equivalence-based instruction and matrices training.Keywords: equivalence-based instruction, matrix, oral production, sentences, cochlear implant

PERFIL SOCIOECONÔMICO DOS BENEFICIÁRIOS RURAIS DO PROGRAMA BOLSA FAMÍLIA NA REGIÃO SUL DO BRASIL

The Bolsa Família Conditional Cash Transfer Program (PBF) has been the subject of studies and inspired anti-poverty programs, within and outside Brazil. Nevertheless, in rural areas, where there is the most part of the poor and extremely poor population and there are many PBF’s beneficiaries, there are few studies to understand its impact and its contribution to rural development. This article presents and analyzes the profile of rural PBF’s beneficiaries in southern Brazil in 2014. Using official data from the Cadastro Único para Programas Sociais (CadÚnico) of the Ministério do Desenvolvimento Social e Combate à Fome (MDS) the article indicates that there is similarity between the studied states and low availability of resources that the PBF’s beneficiaries may convert into work and income, maintaining them with a high level of poverty. Thus, the income transfer policy alone has been insufficient to overcome poverty, which requires that their implementation be associated with other activities and programs guided by the rural territorial development perspective.O Programa de Transferência de Renda Condicionada Bolsa Família (PBF) tem sido alvo de estudos e inspirado programas de combate à pobreza, dentro e fora do Brasil. Apesar disso, há poucos estudos para se compreender seus impactos e sua contribuição para o desenvolvimento rural, região onde se concentra grande parte da população pobre e extremamente pobre e onde há grande quantidade de beneficiários do PBF. Este artigo apresenta e analisa o perfil dos beneficiários rurais do PBF na região Sul do Brasil, em 2014. Utilizando dados oficiais do Cadastro Único para Programas Sociais (CadÚnico) do Ministério do Desenvolvimento Social e Combate à Fome, o estudo indica que há similaridade entre os estados estudados e baixa disponibilidade de recursos para os beneficiários do PBF converterem em trabalho e renda, contribuindo para a continuidade do elevado nível de pobreza. Assim, a política de transferência de renda, isoladamente, tem sido insuficiente para a superação da pobreza, o que requer que sua execução esteja associada a outras ações e programas pautados pela perspectiva do desenvolvimento territorial rural

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological p ..

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

BACKGROUND: In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030 ..

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological trans ..