Análise da ortografia de crianças usuárias de implante coclear Analysis of orthographic errors of children with cochlear implants

O objetivo deste estudo de caso coletivo foi analisar os erros ortográficos de crianças usuárias de implante coclear que freqüentam o ensino fundamental. Foram selecionadas quatro crianças que adquiriram a perda auditiva em período pré-lingual. Todas começaram usar prótese auditiva e freqüentar terapia fonoaudiológica antes de um ano e meio e foram submetidas à cirurgia de implante entre três anos e meio e quatro anos e meio. Foi utilizado o roteiro de observação ortográfica, os erros foram classificados, quantificados, registrados em tabelas e analisados. As quatro primeiras categorias de maior freqüência de erros ortográficos foram: surdos x sonoros, representações múltiplas, "outras" e omissões de letras. Todas as crianças apresentaram um índice de erros muito maior nas atividades envolvendo ditado, em comparação com as atividades de redação. Com isto pudemos inferir que em termos ortográficos o ditado foi mais difícil do que a redação. As causas dos erros que aconteceram em alta freqüência, se relacionavam com padrões acústicos e articulatórios; habilidades metalingüísticas de consciência fonológica, lexical e morfossintática e demais aspectos vinculados à linguagem e oralidade. Entre os possíveis motivos para o índice de erro ter sido muito maior nas atividades envolvendo ditado, pode-se citar o fato que durante o ditado a criança tende a manter uma postura pouco desenvolvida de autocorreção. Outro motivo bastante importante estaria relacionado ao efeito freqüência da palavra e ao repertório vocabular mais restrito devido ao atraso de linguagem. Em linhas gerais, este estudo apontou caminhos que auxiliam o fonoaudiólogo a compreender melhor a produção gráfica do aluno usuário de implante coclear.<br>The aim the present collective case-study was to analyze the orthographic errors of elementary school children with cochlear implants. Four children who became deaf in the pre-lingual period were selected. All subjects started using hearing aids and began speech therapy before 18 months of age and had their cochlear implant surgery between 42 and 54 months. Using an orthographic observation script for dictations and compositions, the errors were classified, quantified, registered and then analyzed. The four categories with the highest incidence of orthographic errors were: voiced x unvoiced phonemes, multiple representations, omission of letters, and "others". All subjects had a much higher incidence of errors in activities involving dictation, in comparison to composition activities, suggesting that, in orthographic terms, dictation was more difficult than composition. The highest incidence of errors was related to acoustic and articulatory patterns, metalinguistic skills of phonological, lexical and morphosyntactic awareness, and other aspects linked to language and pronunciation. Among the reasons why the errors in dictation activities were higher is the fact that, during these activities, children tend to show lower ability of self-correction. Another important reason is related to the frequency effect and the restrict words repertoire due to the language delay. In general, this study identified approaches to help the speech-language therapist to better understand the written production of students with cochlear implants

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events