Análisis de la Enfermería en Atención Primaria en el contexto del sistema sanitario en Brasil

El presente trabajo esboza las estrategias políticas y sociales de la Reforma Sanitaria Brasileña que dio lugar al Sistema Único de Salud (SUS) creado en el año 1988, el cual posibilitó un acceso a la salud pública en el territorio federal brasileño, hasta antes no reconocido, caracterizado por acceso universal y gestión descentralizada. El progreso de la Atención Primaria surge con el nuevo modelo de salud pública, el cual propicia el desarrollo de la Estrategia de Salud a la Familia, un programa que consiste en el acercamiento del profesional sanitario a la familia y comunidad, mediante Equipos de Salud, entre los que figura un médico, un enfermero, dos técnicos, y varios Agentes Comunitarios de Salud. Durante la presente década, los Estados han impulsado la construcción de Unidades Básicas en todos los territorios brasileños. Se considera, pues, una forma de comenzar el siglo apostando por la salud de los ciudadanos, a pesar de las dificultades económicas que conlleva este proyecto, y las críticas destructivas que recibe. A este respecto, la enfermería presenta una posición esencial, siendo el referente en promoción de la salud, prevención de enfermedades, restauración de la salud y alivio del sufrimiento. La consulta de enfermería y la educación para la salud mediante programas colectivos, son las herramientas que permiten llevar a cabo una buena praxis, lo cual requiere por parte del Equipo una atención constante, experiencia personal, formación adecuada y sentimiento de empatía en un contexto sociocultural complicado.Departamento de EnfermeríaGrado en Enfermerí

Intention Understanding in Autism

When we observe a motor act (e.g. grasping a cup) done by another individual, we extract, according to how the motor act is performed and its context, two types of information: the goal (grasping) and the intention underlying it (e.g. grasping for drinking). Here we examined whether children with autistic spectrum disorder (ASD) are able to understand these two aspects of motor acts. Two experiments were carried out. In the first, one group of high-functioning children with ASD and one of typically developing (TD) children were presented with pictures showing hand-object interactions and asked what the individual was doing and why. In half of the “why” trials the observed grip was congruent with the function of the object (“why-use” trials), in the other half it corresponded to the grip typically used to move that object (“why-place” trials). The results showed that children with ASD have no difficulties in reporting the goals of individual motor acts. In contrast they made several errors in the why task with all errors occurring in the “why-place” trials. In the second experiment the same two groups of children saw pictures showing a hand-grip congruent with the object use, but within a context suggesting either the use of the object or its placement into a container. Here children with ASD performed as TD children, correctly indicating the agent's intention. In conclusion, our data show that understanding others' intentions can occur in two ways: by relying on motor information derived from the hand-object interaction, and by using functional information derived from the object's standard use. Children with ASD have no deficit in the second type of understanding, while they have difficulties in understanding others' intentions when they have to rely exclusively on motor cues

Motor intention understanding in children with autistic spectrum disorder

Recenti ricerche hanno mostrato l’esistenza di un meccanismo neurofisiologico che permette la comprensione dell’azione e dell’intenzione in modo immediato. Questo meccanismo è basato su uno specifico tipo di neuroni chiamati neuroni mirror. Fogassi e coll. (2005) mostrano che il sistema motorio è in grado non solo di rappresentare singoli scopi elementari, ma anche di combinarli in rappresentazioni motorie complesse: in catene di atti motori. Quando osserviamo un’azione due sono le principali informazioni che possiamo ricavare: la prima è “che cosa” l’attore sta facendo (il what) e l’altra il “perché” lo sta facendo (il why). La distinzione tra il “what” e il “why” indica che la codifica che avviene a livello motorio non riguarda solo i singoli atti elementari, ma anche la loro organizzazione intenzionale. Il primo studio presentato nella tesi mostra che i bambini con autismo presentano un deficit nel funzionamento delle catene motorie il quale, comporta una comprensione delle intenzioni altrui solo “cognitiva” e non “esperienziale”. Per capire come avvengono i processi di comprensione dell’intenzione quando gli autistici osservano un’azione eseguita da un agente, abbiamo condotto un secondo studio allo scopo di differenziare la comprensione del “what” dell’atto motorio da quella del “why” dell’azione. I risultati ottenuti ci portano a concludere che la visione di una mano che afferra un oggetto con una presa diversa a seconda dello scopo finale dell’azione, sembrerebbe non essere un elemento sufficiente per comprendere l’intenzione dell’agente nei bambini con autismo. Al contrario questa informazione è sufficiente per i bambini con sviluppo tipico. L’alta percentuale di errori di tipo semantico che caratterizza il gruppo degli autistici, rafforza il dato precedente secondo cui la comprensione dell’intenzione altrui avvenga non su base esperienziale, quanto piuttosto attraverso strategie di tipo cognitivo. La loro incapacità di comprendere motoricamente o esperienzialmente l’intenzione altrui potrebbe essere una delle cause dei disturbi nell’interazione sociale manifestati da questi soggetti. Considerando le recenti evidenze che mostrano l’importante ruolo del sistema motorio nella comprensione dell’azione, nell’attribuzione dell’intenzionalità e nella comunicazione (Rizzolatti e Craighero, 2004; Iacoboni e Dapretto, 2006), è plausibile ipotizzare che un danno a un meccanismo comune possa essere la causa sottostante sia del deficit motorio che del deficit cognitivo nell’autismo. Quindi in una parola deficit motorio e deficit cognitivo coincidono

Sex Differences in Affective Facial Reactions Are Present in Childhood

Adults exposed to affective facial displays produce specific rapid facial reactions (RFRs) which are of lower intensity in males compared to females. We investigated such sex difference in a population of 60 primary school children (30 F; 30 M), aged 7–10 years. We recorded the surface electromyographic (EMG) signal from the corrugator supercilii and the zygomatici muscles, while children watched affective facial displays. Results showed the expected smiling RFR to smiling faces and the expected frowning RFR to sad faces. A systematic difference between male and female participants was observed, with boys showing less ample EMG responses than age-matched girls. We demonstrate that sex differences in the somatic component of affective motor patterns are present also in childhood

A developmental study on children's capacity to ascribe goals and intentions to others

The capacity to ascribe goals and intentions to others is a fundamental step in child cognitive development. The aim of the present study was to assess the age at which these capabilities are acquired in typically developing children. Two experiments were carried out. In the first experiment, 4 groups of children (age range = 3 years 2 months-7 years 11 months) were shown pictures representing hand-object interactions and asked what the individual was doing (what task) and why (why task). In the why task, observed handgrip could be either congruent with the most typical action performed with that object (e.g., to drink in the case of a mug) or corresponding to the act of putting away the object. In the second experiment, children saw pictures showing a handgrip either within a context suggesting the most typical use of the object or its being put away. Results showed that by 3-4 years, children are able to state the goal relatedness of an observed motor act (what understanding), whereas the ability to report the intention underlying it (why understanding) is a later and gradual acquisition, reaching a high performance by 6-7 years. These results, besides their intrinsic value, provide an important baseline for comparisons with studies on developmental disorders, also highlighting the relevance of distinguishing what and why understanding. © 2013 American Psychological Association

Morpho-Syntactic Deficit in Children with Cochlear Implant: Consequence of Hearing Loss or Concomitant Impairment to the Language System?

Background: Among implanted children with similar duration of auditory deprivation and clinical history, the morpho-syntactic skills remain highly variable, suggesting that other fundamental factors may determine the linguistic outcomes of these children, beyond their auditory recovery. The present study analyzed the morpho-syntactic discrepancies among three children with cochlear implant (CI), with the aim of understanding if morpho-syntactic deficits may be characterized as a domain-specific language disorder. Method: The three children (mean age = 7.2; SD = 0.4) received their CI at 2.7, 3.7, and 5.9 years of age. Their morpho-syntactic skills were evaluated in both comprehension and production and compared with 15 age-matched normal-hearing children (mean age = 6.6; SD = 0.3). Results: Cases 1 and 2 displayed a marked impairment across morphology and syntax, whereas Case 3, the late-implanted child, showed a morpho-syntactic profile well within the normal boundaries. A qualitative analysis showed, in Cases 1 and 2, language deficits similar to those of normal hearing children with Developmental Language Disorder (DLD). Conclusions: We suggest that a severe grammatical deficit may be, in some implanted children, the final outcome of a concomitant impairment to the language system. Clinical implications for assessment and intervention are discussed

Motor representation of actions in children with autism.

BACKGROUND: Children with Autistic Spectrum Disorders (ASD) are frequently hampered by motor impairment, with difficulties ranging from imitation of actions to recognition of motor intentions. Such a widespread inefficiency of the motor system is likely to interfere on the ontogeny of both motor planning and understanding of the goals of actions, thus delivering its ultimate effects on the emergence of social cognition. METHODOLOGY/PRINCIPAL FINDINGS: We investigate the organization of action representation in 15 high functioning ASD (mean age: 8.11) and in two control samples of typically developing (TD) children: the first one, from a primary school, was matched for chronological age (CA), the second one, from a kindergarten, comprised children of much younger age (CY). We used nine newly designed behavioural motor tasks, aiming at exploring three domains of motor cognition: 1) imitation of actions, 2) production of pantomimes, and 3) comprehension of pantomimes. The findings reveal that ASD children fare significantly worse than the two control samples in each of the inspected components of the motor representation of actions, be it the imitation of gestures, the self-planning of pantomimes, or the (verbal) comprehension of observed pantomimes. In the latter task, owing to its cognitive complexity, ASD children come close to the younger TD children's level of performance; yet they fare significantly worse with respect to their age-mate controls. Overall, ASD children reveal a profound damage to the mechanisms that control both production and pre-cognitive "comprehension" of the motor representation of actions. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that many of the social cognitive impairments manifested by ASD individuals are likely rooted in their incapacity to assemble and directly grasp the intrinsic goal-related organization of motor behaviour. Such impairment of motor cognition might be partly due to an early damage of the Mirror Neuron Mechanism (MNM)