Resumo Na perspectiva do letramento emergente, a alfabetização é influenciada pelas seguintes competências: processamento fonológico, conhecimentos sobre a escrita e linguagem oral. Esta pesquisa teve como objetivo realizar um levantamento sistemático, na base de dados SciELO, de estudos que analisaram o efeito de programas visando ao desenvolvimento de habilidades de letramento emergente em pré-escolares nos últimos dez anos. Dos 15 estudos identificados, oito foram intervenções focadas no desenvolvimento da consciência fonológica, quatro tiveram foco na linguagem oral, baseando-se na leitura compartilhada e três abordaram ambos os tipos de habilidades. Apesar da diversidade, apenas um estudo não obteve efeitos positivos significativos. Os resultados sugerem maior eficácia de programas abordando tanto habilidades linguísticas, quanto metalinguísticas. Questões metodológicas e implicações educacionais são discutidas.

Abstract In the early literacy approach, learning to read is affected by phonological processing, print awareness and oral language skills. This study aimed to conduct a search in the SciELO database for research that analyzed the effect of programs seeking to develop early literacy skills in kindergartners in the past ten years. Fifteen studies were identified: eight were interventions focused on phonological awareness development, four were focused on oral language based on shared reading and three were focused on both sets of skills. Despite the diversity, only one study did not show significant effects. The results suggest that programs that integrate both linguistic and metalinguistic skills are more effective. Methodological questions and educational implications of the studies are also discussed.

Na literatura têm sido discutidos diversos fatores que podem influenciar a dificuldade das tarefas de compreensão de textos e, consequentemente, o desempenho dos sujeitos na avaliação. O objetivo deste estudo é perceber se a dificuldade das tarefas de avaliação da compreensão de textos varia em função da modalidade da tarefa de avaliação (oral versus escrita), do tipo de texto (narrativo versus informativo) e do tipo de compreensão avaliado pelas perguntas apresentadas (literal versus inferencial). Avaliaram-se 300 alunos do quarto ano de escolaridade, administrando quatro testes de compreensão de textos: Teste de compreensão de textos na modalidade oral-narrativo, Teste de compreensão de textos na modalidade oral-informativo, Teste de compreensão de textos na modalidade de leitura-narrativo, Teste de compreensão de textos na modalidade de leitura-informativo. Os resultados mostraram a inexistência de diferenças estatisticamente significativas na média da dificuldade das perguntas de compreensão oral e de compreensão da leitura, entre a dificuldade média das perguntas relativas a texto narrativo e informativo e entre a média da dificuldade das perguntas de compreensão literal e inferencial. Não foram observados efeitos de interação. Discutem-se as implicações destes resultados para a avaliação e intervenção no domínio da compreensão de textos, tendo em conta algumas limitações deste estudo.

Several factors that can influence the difficulty of the text comprehension tasks, and therefore the performance of the individuals, have been discussed in the literature. The goal of this study is to investigate if the difficulty of the text comprehension tasks varies as a function of the modality of the assessment task (oral versus written), the type of text (narrative versus informative) and the type of comprehension assessed by the questions (literal versus inferential). Three hundred students of the fourth grade were assessed using four text comprehension measures: Test of Listening Comprehension of Narrative Texts, Test of Listening Comprehension of Informative Texts, Test of Reading Comprehension of Narrative Texts, and Test of Reading Comprehension of Informative Texts. The results indicated the inexistence of statistically significant differences in the mean difficulty of listening and reading comprehension questions, as well as between the mean difficulty of questions related to narrative and informative texts and literal and inferential questions. No interaction effects were observed. The implications of these results are discussed considering their importance for the selection of the material to be used in the assessment and intervention in the text comprehension area. Some limitations of the study are also highlighted.

Abstract This study investigates the measurement invariance as a function of gender and educational level of the Homework Behavior Questionnaire (Ktpc), an instrument developed to assess students’ homework self-regulation strategies. A sample of 1400 elementary and middle school students was used. Results of confirmatory factor analysis indicated a good fit of the theoretical model composed of three dimensions: planning, execution and evaluation of the homework completion. The results also provided evidence for the existence of metric invariance and partial scalar measurement invariance across boys and girls and across the elementary school and the middle school students. The reliability of the scores in the three dimensions was high. Girls obtained higher scores than boys in planning, execution and evaluation. Middle school students had lower scores in planning compared to the elementary school students. These findings are discussed, and their implications for practice are highlighted.

RESUMO Neste artigo apresenta-se o programa Aprender a compreender torna mais fácil o saber, destinado a alunos do 3º e 4º anos de escolaridade, que tem como objetivo principal o desenvolvimento das competências de compreensão da leitura, de estratégias de leitura e de metacompreensão. O programa foi implementado com 1.142 alunos do 4º ano de escolaridade. Na avaliação dos resultados, recorreu-se a um design de grupo único com pré e pós-teste. Os resultados indicaram a presença de diferenças estatisticamente significativas entre os dois momentos de avaliação, e os resultados obtidos por esses alunos no exame de língua portuguesa de 2012 mostraram que: a percentagem de alunos que obtêm a classificação A e B é superior à média nacional; a percentagem dos que obtêm D e E é inferior à média nacional. Apontam-se como linhas de investigação futura a replicação do estudo com a inclusão de um grupo de controlo e a avaliação da perceção dos professores sobre o programa e a sua eficácia.

ABSTRACT In this paper, the intervention program Aprender a compreender torna mais fácil o saber for 3rd and 4th primary school grades is presented. Its main goal is to develop students’ reading comprehension, reading strategies and metacomprehension competences. The program was administered to a sample of 1,142 students of the 4th grade. The evaluation of results was designed as a single group with both pre- and post-tests. The results showed statistically significant differences between both moment of evaluation, and the results obtained by these students in the Portuguese Language Exam in 2012 showed that: the percentage of students that obtained A and B scores was higher than the national average; the percentage of the ones who obtained D and E scores was lower than the percentages obtained nationally. Future studies should be designed with the inclusion of a control group and should evaluate teachers’ perceptions about the program and its efficacy.

RESUMEN Este artículo presenta el programa Aprender a compreender torna mais fácil o saber, para alumnos de 3º y 4º de la escolaridad primaria, y tiene como su objetivo principal el desarrollo de las habilidades de comprensión lectora, de estrategias de lectura y de metacomprensión. El programa se implementó con 1.142 estudiantes de 4º grado. Para evaluar los resultados se utilizó un diseño de grupo único con pre y post-test. Los resultados indicaron diferencias estadísticamente significativas entre los dos momentos de evaluación y los resultados obtenidos por estos estudiantes en el de examen de lengua portuguesa en 2012 revelaron que: el porcentaje de estudiantes que obtuvieron la clasificación A y B es más alto que el promedio nacional; el porcentaje de aquellos que obtuvieron D y E es menor que el promedio nacional. Se señalan cómo directrices para futuras investigaciones un estudio con la inclusión de un grupo control y la evaluación de la percepción de los maestros sobre el programa y su eficacia.

Introdução: As próteses metálicas auto-expansíveis (PMAE) como ponte para cirurgia são uma alternativa à cirurgia urgente nas neoplasias estenosantes do colon esquerdo. No entanto, os benefícios são controversos. A Sociedade Europeia de Endoscopia não as recomenda como ponte para cirurgia desde 2014, em doentes de baixo risco cirúrgico, pelo possível aumento de recidiva neoplásica. Métodos: Avaliação retrospetiva dos doentes com neoplasia oclusiva do colon esquerdo candidatos a tratamento curativo, que colocaram PMAE como ponte para cirurgia ou que foram submetidos diretamente a tratamento cirúrgico urgente. Avaliada a morbilidade e mortalidade pós-operatória, complicações relacionadas com as PMAE e sobrevivência. O nosso objetivo foi comparar os resultados das PMAE como ponte para cirurgia com o tratamento cirúrgico urgente nas neoplasias oclusivas do colon esquerdo. Resultados: Avaliados 42 doentes (grupo submetido a PMAE: 27; grupo submetido a cirurgia:15). Não existem diferenças entre os dois grupos no que diz respeito à idade classificação ASA e o estadio da neoplasia. O sucesso técnico das PMAE foi de 88,9% e o sucesso clínico da prótese foi de 85,2%. Ocorreram 3 perfurações após colocação das PMAE. No grupo submetido a cirurgia, a realização de estoma foi superior (86,7% vs 25,9%), p < 0,001), e verificou-se um menor número de dias de internamento hospitalar total, embora sem resultado estatisticamente significativo (18,9 vs 26,3 dias, p = 0,051). PMAE versus cirurgia: não existem diferenças no que diz respeito à constituição de estomas provisórios (57,1% vs 61,5%, p = 0,84), estomas definitivos (42,8% vs 38,5%, p = 0,84), sucesso de anastomose primária (86,7% vs 66,7%, p = 0,22) e classificação de Clavien-Dindo (≥III:36% vs 58,2% p = 0,24). A sobrevida aos 1 e 5 anos foi semelhante nos dois grupos (PMAE 1-5 anos vs cirurgia 1-5 anos: 100%-56% vs 93%-43%, p = 0,14), bem com a recidiva aos 3 e 5 anos (PMAE 3-5 anos vs cirurgia 3-5 anos 24%-50% vs 20%-36%, p = 0,68). Conclusões: A realização de estoma foi superior nos doentes submetidos a tratamento cirúrgico, no entanto, não há diferenças entre os dois grupos relativamente às complicações pós-cirurgicas, sucesso de anastomose primária, recidiva e mortalidade.

Introduction: Self-expanding metal stents (SEMS) as a bridge to surgery have been used as an alternative for acute malignant left-sided colonic obstruction. However, the benefits are uncertain. The European Society of Gastrointestinal Endoscopy no longer recommends their use in patients with low surgical risk because of the risk of tumor recurrence. Methods: Patients admitted for acute malignant left-sided colonic obstruction who underwent SEMS as a bridge to elective surgery or urgent surgery were retrospectively evaluated. Postoperative morbidity/mortality, stent complications and survival were recorded. Our aim was to compare the outcome between preoperative SEMS and direct emergent surgery in acute left-sided malignant colonic obstruction. Results: 42 patients were included (SEMS group: 27 and surgery group: 15). There were no differences between groups in relation to age, ASA classification and tumor stage. The technical success of SEMS was 88.9% and the clinical success was 85.2%. There were three SEMS related perforations. In the surgery group, the stoma rate was higher (86.7% vs 25.9%, p < 0.001) and there was a trend for a lower length of hospital stay (18.9 days vs 26.3 days, p = 0.051). SEMS verses surgery group: There were no differences in the rate of temporary stoma (57.1% vs 61.5%, p = 0.84), definitive stoma (42.8% vs 38.5%, p = 0.84), success of primary anastomosis (86.7% vs 66.7%, p = 0.22) and Clavien-Dindo classification (≥III: 36% vs 58.2% p = 0.24). Overall survival at 1/5 years was identical in the two groups 100%/56% in the SEMS group vs 93%/43% in the surgery group, p = 0.14), as well as tumor recurrence at 3/5 years (24%/50% vs 20%/36% respectively, p = 0.68). Conclusions: SEMS are associated with a lower overall stoma rate and a higher primary anastomosis rate. However, there are no differences in complications, overall survival and recurrence between the groups.

A obstrução colorretal maligna é uma complicação de neoplasias em estadio avançado. A obstrução pode resultar de neoplasias colorretais, neoplasias de órgãos adjacentes ao cólon ou metastização. A metastização cólica de neoplasias gástricas é rara. A ingestão de corpos estranhos não constitui um evento raro e a maioria dos casos cursa sem sintomas ou complicações. Contudo, estes podem ficar retidos em áreas de estreitamento ou angulação do lúmen intestinal. Os autores descrevem uma rara forma de apresentação clínica de impactação de corpo estranho numa estenose retal maligna secundária a metástases de neoplasia gástrica, que condicionou obstrução cólica maligna. Após remoção endoscópica do corpo estranho, verificou-se resolução da sintomatologia sem necessidade de tratamento cirúrgico ou colocação de prótese. Este caso ilustra a importância da inspeção minuciosa das estenoses malignas previamente à colocação de prótese para exclusão de outras causas de obstrução cólica, como corpo estranho impactado.

Malignant colorectal obstruction is a serious complication of advanced cancers. The obstruction can be caused by colorectal cancer, adjacent organ cancer or distant metastases. Rectal metastases from gastric cancer are rare. Foreign body ingestion is not a rare event and the majority of them causes no symptoms or complications. Nevertheless, they are likely to stop at any narrowing or angulation of the intestinal lumen. The authors describe a rare clinical presentation of an impacted foreign body in a pathological narrowing secondary to rectal metastasis of a gastric neoplasia that caused an acute malignant colonic obstruction. After endoscopic removal of the foreign body, there was complete resolution of symptoms avoiding surgery or palliative stenting. This case report highlights the need of careful inspection of colonic malignant strictures before stenting to exclude other causes of colonic obstructions, as an impacted foreign body.

Abstract An effective reading comprehension measurement demands robust psychometric tools that allow teachers and researchers to evaluate the educational practices and track changes in students’ performance. In this study, we illustrate how Rasch model can be used to attend such demands and improve reading comprehension measurement. We discuss the construction of two reading comprehension tests: TRC-n, with narrative texts, and TRC-e, with expository texts. Three vertically scaled forms were generated for each test (TRC-n-2, TRC-n-3, TRC-n-4; TRC-e-2, TRC-e-3 and TRC-e-4), each meant to assess Portuguese students in second, third and fourth grade of elementary school. The tests were constructed according to a nonequivalent groups with anchor test design and data were analyzed using the Rasch model. The results provided evidence for good psychometric qualities for each test form, including unidimensionality and local independence and adequate reliability. A critical view of this study and future researches are discussed.

Background and aims: There are contradictory findings regarding long-term outcome in patients with obscure gastrointestinal bleeding and negative capsule endoscopy. Factors associated with rebleeding after a negative videocapsule are not entirely known. Objective: The aim of this study was to compare the rebleeding rate between negative and positive capsule endoscopy patients and to identify predictive factors for rebleeding in patients with negative findings. Material and methods: Consecutive patients with obscure gastrointestinal bleeding referred to a single center over a period of 5 years were identified. After exclusion of patients with a follow time < 6 months, 173 patients were included. Clinical information was retrospectively collected from medical records. Rebleeding was defined as evidence of melena/hematochezia, a drop in hemoglobin of ≥ 2 g/dL, or the need for transfusion 30 days after the index episode. Results: The mean age was 61.7 years and 60% were female. The median follow up time was 27 months. Most patients were referred for occult gastrointestinal bleeding (67.1%) while 32.9% were referred for overt bleeding. More than 50% of the patients had negative capsule endoscopy. The rebleeding rate in negative capsule endoscopy is 16%, with a mean follow-up time of 25.8 months and is significantly lower than positive capsule endoscopy (16% vs. 30.2%, p = 0.02). Rebleeding after negative capsule endoscopy is higher in patients who need more transfusions of packet red blood cells before capsule endoscopy (3.0 vs. 0.9, p = 0.024) and have overt bleeding (46% vs. 13.9%, p = 0.03). In 53% of these patients, rebleeding occurs > 12 months after a negative capsule endoscopy. Conclusions: Patients with obscure gastrointestinal bleeding and a negative capsule endoscopy had a significantly lower rebleeding rate and can be safely followed. However, a higher transfusion of red blood cells previous to capsule endoscopy and an overt bleeding are associated with a higher rebleeding. So, it is reasonable to consider that these patients may benefit of at least one year of follow-up.

Background and aims: Clostridium difficile infection (CDI) constitutes an important cause of antibiotic-associated diarrhea. Recurrence after first-line treatment with antibiotics is high and fecal microbiota transplantation (FMT) may be effective for refractory and recurrent CDI. This series aims to describe the efficacy of FMT in the treatment of refractory and recurrent CDI. Methods: A prospectively recorded single-centre case series of patients with persistent or recurrent CDI treated with FMT between June 2014 and March 2015 was analyzed. Primary and secondary outcomes were defined as resolution of diarrhea without recurrence of CDI within 2 months after one or more FMT, respectively. A descriptive analysis was performed. Results: 8 FMT were performed in 6 patients, 3 with refractory CDI and 3 with recurrent CDI. The median age of recipients was 71 years and 66.7% were women. One FMT was delivered through colonoscopy and the remaining 87.5% through esophagogastroduodenoscopy. One upper FMT was excluded due to recurrence of CDI after antibiotic exposure for a respiratory infection. The overall cure rate of FMT was total with lower route and 83.3% with upper route. Primary cure rate was achieved in 83.3% of patients and secondary cure rate was achieved in all patients. Median time to resolution of diarrhea after FMT was 1 day and no complications were reported during follow-up. Conclusion: FMT appears to constitute a safe and effective approach in the management of refractory and recurrent CDI. Difference between primary and secondary cure rates may result of insufficient restoration of intestinal microbiota with a single FMT.

A enteroscopia por cápsula é um dos principais métodos de diagnóstico de lesões do intestino delgado, em especial no contexto da hemorragia digestiva obscura. A enteroscopia por cápsula revolucionou a avaliação do intestino delgado e a deteção e tumores. No entanto, os tumores do intestino delgado nem sempre são diagnosticados por enteroscopia por cápsula. Vários artigos que comparam a enteroscopia por cápsula com outros métodos de diagnóstico, como a enteroscopia por duplo balão ou a enterografia por tomografia computorizada/ressonância colocam em causa o elevado valor preditivo negativo da cápsula endoscópica na deteção de tumores do intestino delgado. Os autores descrevem o caso de uma doente com hemorragia digestiva obscura manifesta devido a um GIST diagnosticado por enterografia por TC abdominal após realização de duas enteroscopias por cápsula que foram negativas. Este caso demonstra que a enteroscopia por cápsula pode não diagnosticar lesões com significado clinico e realça a importância de utilizar outros métodos de diagnóstico, especialmente em doentes com elevado índice de suspeição de tumores do intestino delgado ou hemorragia persistente/recorrente.

Capsule endoscopy is widely accepted as the preferred diagnostic test in the evaluation of small bowel diseases, especially in the setting of obscure gastrointestinal bleeding. It has revolutionized small bowel examination and has improved the detection of small bowel tumors. However, small bowel tumors are sometimes missed by capsule endoscopy. Furthermore, there are several recent reports comparing capsule endoscopy with other diagnostic modalities, such as double balloon enteroscopy and CT/RM enterography, that challenge the reportedly high negative predictive value of capsule endoscopy in detecting small bowel tumors. We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.

Background: Capsule endoscopy is a first line examination to evaluate obscure gastrointestinal bleeding. The identification of factors associated with the detection of lesions by capsule endoscopy could improve resource utilization and patient selection. Objectives: To identify factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding. Methods: Retrospective, single-center study, including 203 patients (214 capsule endoscopy procedures) submitted to capsule endoscopy in the setting of obscure gastrointestinal bleeding. Type of obscure gastrointestinal bleeding, number of units of packed red blood cells transfused, type of positive finding, number of endoscopy studies performed prior to capsule endoscopy, comorbidities, medication and Charlson index were evaluated. Overt bleeding was subdivided into ongoing and previous gastrointestinal bleeding. Only lesions with high hemorrhagic potential (P2) were classified as positive findings. Results: The mean age was 62.2 years and 59.7% of patients were female. Most patients were referred for occult gastrointestinal bleeding (64.5%), while 35.5% were referred for overt gastrointestinal bleeding (63.2% previous-overt gastrointestinal bleeding). The most frequent positive findings included ulcers/erosions (34%) and angioectasias (32%). In univariate analysis, the identification of positive findings was significantly higher in those with ongoing-overt bleeding (p < 0.001), advanced age (p = 0.003), increasing number of pre-capsule endoscopies (p < 0.001), increasing transfusion requirements (p < 0.001), moderate/severe renal disease (p = 0.009) and antiplatelet drugs (p = 0.021) and NSAID intake (p = 0.005). In multivariate analysis, positive findings were significantly higher only in those with ongoing-overt bleeding (odds ratio [OR] 18.68, 95% confidence interval [CI] 3.98-85.6, p < 0.001), higher transfusion requirements (OR 1.23, 95% CI 1.1-1.4, p < 0.001) and NSAID intake (OR 5.9, 95% CI 2.1-17.3, p = 0.001). Conclusions: Capsule endoscopy should be used early in obscure gastrointestinal bleeding. Ongoing-overt bleeding, higher transfusion requirements and NSAIDs intake were associated with positive findings on capsule endoscopy.

O pólipo fibróide inflamatório (PFI) é uma lesão subepitelial (LSE) gastrointestinal incomum e benigna. As características dos PFIs gástricos na ultrassonografia endoscópica (EUS) foram esporadicamente descritas em relatos de casos clínicos e séries pequenas. No entanto, o diagnóstico diferencial e tratamento são frequentemente um desafio. Apresentamos um caso invulgar de uma LSE gástrica volumosa, com sintomas obstrutivos face ao seu efeito valvular sobre o piloro (‘‘ball valve syndrome’’) e anemia por erosão da mucosa. Na avaliação por EUS observou-se uma LSE hipoecogénica mas heterogénea no antro distal, com 50 mm, e pedículo longo na dependência da segunda e terceira camadas (mucosa profunda e submucosa). Estava mantida a integridade da quarta camada (muscular), e não foram observadas adenopatias peri-lesionais. Optou-se pela exérese endoscópica face à sintomatologia referida. A análise histológica com estudo imuno-histoquímico foi compatível com PFI. Os PFIs raramente atingem estas dimensões ou causam sintomas. Apesar da sua etiologia benigna, a ressecção endoscópica foi importante para estabelecer um diagnóstico histológico bem como tratamento. Destaca-se a importância da EUS no diagnóstico diferencial desta lesão. A literatura sobre PFIs é revista.

Inflammatory fibroid polyp (IFP) is an unusual benign gastrointestinal subepithelial tumor (SET). The endosonographic (EUS) features of IFPs were sporadically reported on imagingtips or small case series study. However, the differential diagnosis and optimal treatment of gastric IFP is still challenging. We report an unusual case of a large erosioned and prolapsing gastric submucosal lesion, presenting primarily with obstructive symptoms (‘‘ball valve syndrome’’) and anemia. On EUS examination, a 50mm SET in the distal antrum was seen, with hypoechoic but heterogeneous echo-pattern, located in the second and third sonographic layers of the gastric wall (deep mucosal and submucosal). The fourth (muscle) layer was intact; no peri-lesional adenopathies were identified. A decision was made to proceed to endoscopic treatment because of the mentioned symptoms. Histopathologic evaluation of the resected specimen with immunohistochemical staining was consistent with the diagnosis of IFP. IFP rarely reach these large dimensions or cause symptoms. Despite its benign etiology, endoscopic resection was important in both establishing a histologic diagnosis and treatment. EUS was crucial in the differential diagnosis. The literature concerning IFP is also reviewed.