Singularidades e impacto social del autismo severo en Brasil / Singularidades e impacto social do autismo severo no Brasil / Singularities and social impact of severe autism in Brazil

RESUMEN El autismo severo es uno de los niveles de deterioro del trastorno del espectro autista, descrito en el Manual diagnóstico y estadístico de los trastornos mentales en su quinta versión. El presente estudio describe el autismo severo según la literatura científica y discute, a partir de la información producida por los participantes, su impacto social en la vida familiar de este sujeto. La investigación se caracteriza por ser descriptiva-explicativa con datos cuantitativos y cualitativos con una perspectiva de enfoque cualitativo para el análisis e interpretación de datos. Los resultados apuntan al intenso sufrimiento experimentado por las personas con autismo severo y sus familiares, así como a los impactos sociales debido a la ausencia de políticas públicas efectivas que favorezcan la calidad de vida e inclusión social de estos sujetos. Se concluye que la invisibilidad del autismo severo en la sociedad brasileña es un factor que promueve y perpetúa los mecanismos de exclusión social, además de la evidencia de la necesidad de más estudios, investigación y difusión sobre el tema.

RESUMO O autismo severo se constitui um dos níveis de comprometimento do Transtorno do Espectro Autista, descrito no Manual de Diagnóstico e Estatístico de Transtornos Mentais em sua quinta versão. O presente estudo descreve o autismo severo segundo a literatura científica e discute, a partir das informações produzidas pelos participantes, seu impacto social na vida familiar desse sujeito. A pesquisa se caracteriza como descritiva-explicativa com dados quantitativos e qualitativos numa perspectiva de abordagem qualitativa para análise e interpretação dos dados. Os resultados apontam para intensos sofrimentos vivenciados pela pessoa com autismo severo, bem como por seus familiares, além de impactos sociais pela ausência de políticas públicas efetivas que favoreçam sua qualidade de vida e inclusão social do sujetos. Conclui-se que a invisibilidade do autismo severo na sociedade brasileira, é um fator promotor e perpetuador de mecanismos de exclusão social, além da evidência da necessidade de mais estudos, pesquisas e divulgações sobre o tema.

ABSTRACT Severe autism is one of the levels of impairment of Autistic Spectrum Disorder, described in the Diagnostic and Statistical Manual of Mental Disorders in its fifth version. This study describes severe autism according to the scientific literature and discusses, from the information produced by the participants, its social impact on the family life of this subject. The research is characterized as descriptive-explanatory with quantitative and qualitative data in a perspective of qualitative approach for data analysis and interpretation. The results point to the intense suffering experienced by people with severe autism, as well as their families, as well as social impacts due to the absence of effective public policies that favor their quality of life and social inclusion. It is concluded that the invisibility of severe autism in Brazilian society is a factor that promotes and perpetuates mechanisms of social exclusion, besides the evidence of the need for further studies, research and dissemination on the subject.

Contribuições da abordagem histórico-cultural na educação de alunos autistas / Contribuciones del abordaje histórico-cultural a la educación de alumnos autistas / Contributions of the cultural-historical approach to the education of autistic students

O presente trabalho apresenta a abordagem histórico-cultural de Vigotsky e suas contribuições para a educação de alunos com autismo. Este artigo é decorrente de uma pesquisa-ação realizada a dez alunos com autismo e seus professores numa escola especializada do interior do Estado de São Paulo, Brasil, no período de 2000 a 2006. Os resultados dizem respeito ao papel mediador do professor na reconstituição e na melhora da vivência emocional do aluno para que ele transcenda das reações afetivas imediatas para outras mais duradouras. Conclui-se que a abordagem histórico-cultural e a integração social favorecem uma aprendizagem mais significativa para o aluno autista.

En este trabajo se presentan el abordaje histórico-cultural de Vigotsky y sus contribuciones a la educación de alumnos autistas. Este artículo es resultado de una investigación-acción realizada a diez alumnos y sus profesores en una escuela especializada del interior de San Pablo, Brasil, en el periodo 2000 a 2006. Los resultados hablan acerca del papel mediador del profesor en la reconstitución y el progreso de la vivencia emocional del alumno y sobre la trascendencia de reacciones afectivas inmediatas para otras más duraderas. Se concluye que el abordaje histórico-cultural y la integración social favorecen significativamente el aprendizaje de los alumnos autistas.

This paper deals with Vigotsky´s cultural-historical approach and its contributions to the education of autistic students. This article is the result of a research-action carried out with ten autistic students and their teachers in a specialized school from the state of Sao Paulo, Brazil, during the period 2000 to 2006. Results proved the teachers´ mediating role within the rebuilding and improvement of students' emotional experience and the significance of both immediate and more lasting affective reactions. As conclusions, it states that both the cultural-historical approach and social integration favor autistic students´ learning significantly.

Results of whole brain radiation therapy in patients with brain metastases from colorectal carcinoma.

AIMS AND BACKGROUND: Carcinoma of the colon-rectum is an infrequent cause of brain metastases, constituting 1.5% of all metastatic lesions to the brain. We reviewed our experience in the treatment of brain metastases from colorectal cancer to define the efficacy of whole brain radiation therapy as a palliative measure in this setting of patients. METHODS: Twenty-three consecutive cases of brain metastasis from colorectal cancer treated between 1999 and 2004 were identified in the files of the Division of Radiotherapy of the A Businco Regional Oncological Hospital, Cagliari. Their records were reviewed for patient and tumor characteristics and categorized according to the RTOG RPA classes. RESULTS: Fifteen patients (65%) had multiple metastases. Twenty-one patients (91%) showed extracranial metastases. Fourteen patients were classified as RTOG RPA class II and 9 class III. The median radiation dose delivered was 2000 cGy in 5 fractions in one week (range, 20-36 Gy). In 14 of 20 assessable patients (70%), symptomatic improvement was observed. The median follow-up and survival time for all the patients, 12 females and 11 males, was 3 months. In 3 patients only the cause of death was the brain metastasis. CONCLUSIONS: Despite the disappointing survival time, external radiation therapy to the whole brain proved to be an efficacious palliative treatment for patients with multiple or inoperable brain metastasis from colorectal cancer.

Comparative evaluation of two hypofractionated radiotherapy regimens for painful bone metastases.

AIMS AND BACKGROUND: In 75% of the patients with bone metastases (BM) pain is the dominant symptom. Radiotherapy (XRT) plays a major role in the palliation of pain in patients with BM. Several schedules of short and long fractionation XRT are used in clinical practice, with hypofractionated treatments being even more attractive for practical reasons. A considerable body of evidence supports the clinical use of short schedules and single-dose XRT. We retrospectively evaluated the efficacy of two short fractionated schedules of 8 Gy as a single dose and 20 Gy in 5 fractions in relieving pain in patients with multiple uncomplicated BM. METHOD: From January to December 2001, 130 patients with 146 painful BM were treated with palliative localized XRT. There were 42 males and 88 females with a median age of 58 years (range 28-84). The commonest sites of treatment were the spine (59.6%) and pelvis (14.4%). The primary endpoint was clinically significant pain relief in the first six months of follow-up evaluated with the IAEA (International Atomic Energy Agency) pain measurement score measuring pain severity and pain frequency. Analgesic use was also recorded before and after treatment as drug frequency and drug severity. Patients with painful BM from any primary tumor site were irradiated. Treatment schedules consisted of a course of XRT with 4 Gy/fraction/day (total dose: 20 Gy/5 fractions) (group A, 59 lesions) or with a single dose of 8 Gy (group B, 87 lesions). RESULTS: There was no significant difference in complete response (CR) rates between treatment schedules: complete pain relief was achieved in 17/59 lesions (29%) in the fractionated group and in 29/87 lesions (33%) in the single-dose group. Also the overall response (complete + partial) was similar: 35/59 lesions (60%) in group A and 60/87 (69%) in group B. The minimum, maximum and median follow-up was 3, 23, and 9 months, respectively, for group A and 3, 20, and 11 months for group B. The actuarial median duration of pain relief was similar: 4.5 months in group A and 4 months in group B. No particular side effects were recorded in either group. CONCLUSIONS: There were no differences between the two fractionation schedules used in our study with regard to pain relief and use of analgesics. Palliation of pain was obtained in approximately two thirds of patients with both schedules, providing further evidence of the similar efficacy between single and multiple fractions. With regard to pain response these data justify a recommendation for the use of a more simple and convenient 8 Gy single fraction for the palliation of uncomplicated BM.