Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Desarrollo de habilidades conductuales maternas para promover la alfabetización inicial en niños preescolares / Development of maternal skills to implement early literacy with preschool children / Desenvolvimento de habilidades condutuais maternas para promover a alfabetização inicial em crianças pré-escolares

El objetivo del presente estudio fue probar la efectividad de un programa conductual (taller) dirigido a madres de familia de estrato sociocultural bajo, para capacitarlas en la realización de actividades y estrategias para promover en sus hijos preescolares habilidades lingüísticas y preacadémicas relacionadas con la alfabetización inicial. El programa se enfocó en dos contextos específicos de interacción: la lectura conjunta de cuentos y el juego con títeres. Participaron 20 madres, con prácticas alfabetizadoras limitadas, cuyos hijos preescolares mostraron pocas habilidades preacadémicas y lingüísticas. Diez madres conformaron el Grupo Experimental, recibiendo el programa de intervención y otras diez fungieron como Grupo Control. Se realizaron tres sesiones de evaluación (pre test, post test y seguimiento) y siete sesiones de intervención. El programa se aplicó de manera grupal y se utilizaron técnicas de exposición oral, discusión en grupo, modelamiento, juego de roles, retroalimentación y práctica reforzada. Los resultados mostraron que el programa fue eficaz para desarrollar algunas de las prácticas alfabetizadoras en las madres. Los mayores efectos se observaron en el contexto interactivo de lectura conjunta de cuentos. Se discuten los resultados y limitaciones del estudio, y se derivan algunas sugerencias para programas futuros.

The aim of this study was to test the effectiveness of a behavioral program aimed to mothers from low socio-cultural background in order to train them in conducting activities and strategies to promote language and pre-academic skills related to early literacy in their preschool children. The program was carried out focusing on two interactive contexts: joint reading of stories and puppet play. 20 women participated, with limited literacy practices whose preschool children showed low levels in pre-academic and linguistic skills. 10 mothers formed the experimental group, receiving the intervention program and 10 served as control group. There were three testing sessions (pretest, post-test and follow-up) and seven intervention sessions. The program was implemented in a group mode and it used techniques such as oral presentation, group discussion, modeling, role playing, feedback and reinforced practice. Results showed that the program was effective in developing some of the literacy practices in mothers. The main effects were observed in the interactive context of joint reading of stories. The results and limitations of the study are discussed and some recommendations are given for future programs.

O objetivo do presente estudo foi provar a efetividade de um programa condutual (oficina) dirigido a mães de família de classe sociocultural baixa, para capacitá-las na realização de atividades e estratégias para promover em seus filhos pré-escolares habilidades linguísticas e pré-acadêmicas relacionadas com a alfabetização inicial. O programa enfocou-se em dois contextos específicos de interação: a leitura conjunta de contos e brincadeiras com marionetes. Participaram 20 mães, com práticas alfabetizadoras limitadas, cujos filhos pré-escolares mostraram poucas habilidades pré-acadêmicas e linguísticas. Dez mãe formaram o Grupo Experimental, recebendo o programa de intervenção e outras dez participaram como Grupo de Controle. Realizaram-se três sessões de avaliação (pré-teste, pós-teste e acompanhamento) e sete sessões de intervenção. O programa foi aplicado de maneira grupal e se utilizaram técnicas de exposição oral, discussão em grupo, modelagem, jogo de papéis, retroalimentação e prática reforçada. Os resultados mostraram que o programa foi eficaz para desenvolver algumas das práticas alfabetizadoras nas mães. Os maiores efeitos foram observados no contexto interativo de leitura conjunta de contos. Discutemse os resultados e limitações do estudo, e se derivam algumas sugestões para programas futuros.

Habilidades matemáticas en alumnos de bajo nivel sociocultural / Mathematical skills in students from a low social and cultural stratum / Habilidades matemáticas em alunos de baixo nível sociocultural

La temática abordada es la calidad de la educación básica en México. Con el propósito de dar cuenta del proceso de desarrollo de diversas habilidades matemáticas en alumnos de primer grado de primaria, se realizó un estudio longitudinal en el cual participaron 169 alumnos de estrato sociocultural bajo. Se aplicó un instrumento referido a criterio y basado en análisis de tareas, que permitió analizar los aciertos y errores a lo largo del ciclo escolar 2004-2005. Los resultados indican que los alumnos ingresaron con deficiencias preacadémicas, que se desarrollaron algunas habilidades, pero que los niveles de aptitud matemática fueron bajos al finalizar el curso. Se discuten las implicaciones de los resultados y se proponen alternativas para la educación, basadas en el modelo conductual de desarrollo psicológico.

In this paper, the quality of primary education in Mexico is dealt with A longitudinal study was carried out with the aim of analyzing the process of development for various mathematical skills with first grade students; 169 students from a low social and cultural stratum participated. An instrument referred to criteria and based on task analysis was used to analyze the errors and the correct responses throughout the 2004-2005 school year Results show that students had enrolled with previous academic deficiencies and developed some skills; however, the levels of mathematical skills were still low at the end of the school term. The implications of these results are discussed and some alternatives for education based on a behavioural model of psychological development are proposed.

Neste artigo, é examinada a qualidade do ensino primária em México. Para dar conta do processo de desenvolvimento de várias habilidades matemáticas nos alunos do primeiro grau de ensino primária, foi realizado um estudo longitudinal em que participaram 169 alunos de estrato sociocultural baixo. Foi aplicado um instrumento referido a critério e baseado em análise de tarefas, que possibilitou a análise de acertos e erros durante o ciclo escolar 2004-2005. Os resultados sinalam que os alunos tenham deficiências pré-acadêmicas, que desenvolveram algumas habilidades, mais que os níveis de aptitude matemática foram baixos ao final do curso. São discutidas as implicações dos resultados e são propostas alternativas para a educação, baseadas no modelo condutista de desenvolvimento psicológico.