Background: Although immunisation services are provided free at all public health facilities in South Africa, immunisation coverage remains variable and disease outbreaks still occur. The coverage rate in the Overberg district is recorded as 75.8%, below the national target of 90% (Western Cape Government Provincial Treasury 2013:2). The researcher wanted to understand what the barriers to accessing immunisation services were and how this might relate to other primary health care services. Methods: The researcher visited 22 households and interviewed nine mothers who had brought their children to Zwelihle Clinic to be immunised and nine community health workers servicing the Zwelihle community in the Overberg district, Western Cape Province. Findings: A key finding is that the data does not reflect the actual situation – children in the community either are immunised at other facilities or have left the catchment area, hence strong relationships between the facility and the community and an electronic patient tracking system become important. Findings impacting access to services include the attitude of administrative staff, waiting times and the impact of migratory communities. Recommendations are made to improve the quality of data, provide training to administrative staff, improve patient education, reduce waiting times and improve the relationship between the clinic and the community in order to better track patient migration / Health Studies / M.A. (Public Health)

<p>Syftet med denna undersökning var att undersöka barnmorskans syn på kostrådgivning till gravida kvinnor, om och hur de ger information om kost och i så fall vad de informerar om. Vidare undersöktes till vilken grad barnmorskorna på mödravårdscentralerna följer de rekommendationer om kost till gravida kvinnor som Svenska Livsmedelsverket tagit fram. En deskriptiv tvärsnittsstudie genomfördes bland samtliga barnmorskor på mödravårdscentraler i Uppsala län. Det var 36 barnmorskor som deltog i studien (53 % svarsfrekvens) och som besvarade ett webbaserat frågeformulär. Resultatet från undersökningen visar att barnmorskorna ofta ger kostråd till den gravida kvinnan i samarbete med dietisten. Informationen ges då för det mesta både muntligt och skriftligt. Vidare visar resultatet att barnmorskorna anser att det är viktigt att ge kostråd till gravida kvinnor och att de allra flesta kvinnor får kostrådgivning på mödravårdscentralen. Barnmorskorna anser att de och den gravida kvinnan har ett gemensamt ansvar när det gäller information angående kost. Barnmorskorna grundar kostrådgivningen främst på Svenska Livsmedelsverkets rekommendationer och undersökningen visar att de informerar om det mesta som det Svenska Livsmedelsverket tar upp angående kost under graviditeten. Slutsatsen av denna undersökning är att barnmorskorna ger en individuellt anpassad kostrådgivning som följer det Svenska Livsmedelsverkets rekommendationer.</p> / <p>The aim of this study was to examine what view the midwives have on nutritional guidance towards pregnant women, if they give information regarding diets, and if so, how they inform pregnant women, and also what the information consists of. Furthermore, the aim of this study was to determine how the midwives comply with the recommendations given by the Swedish National Food Administration. A descriptive cross-sectional study was carried out among all midwives at the maternity clinics in the county of Uppsala. There were 36 midwives that participated in the study (53 %) which consisted of a web based questionnaire. The result of this study indicated that the midwives frequently give nutritional guidance to the pregnant woman in collaboration with the dietician. The pregnant woman often receives both verbal and written information. The results also indicate that the midwives believe that it is important to give nutritional guidance to pregnant women and that most of them get this guidance at the maternity clinic. The attitude of the midwives is that they, together with the pregnant woman, have a mutual responsibility when it comes to information about nutrition during pregnancy. The midwives nutritional guidance is based on the given recommendations of the Swedish National Food Administration, and the study also shows that the information given by the midwife corresponds with the information that the Swedish National Food Administration emphasise. Therefore the conclusion of this study is that the midwives give an individually adjusted nutritional guidance which corresponds to the recommendations given by the Swedish National Food Administration.</p>

Syftet med denna undersökning var att undersöka barnmorskans syn på kostrådgivning till gravida kvinnor, om och hur de ger information om kost och i så fall vad de informerar om. Vidare undersöktes till vilken grad barnmorskorna på mödravårdscentralerna följer de rekommendationer om kost till gravida kvinnor som Svenska Livsmedelsverket tagit fram. En deskriptiv tvärsnittsstudie genomfördes bland samtliga barnmorskor på mödravårdscentraler i Uppsala län. Det var 36 barnmorskor som deltog i studien (53 % svarsfrekvens) och som besvarade ett webbaserat frågeformulär. Resultatet från undersökningen visar att barnmorskorna ofta ger kostråd till den gravida kvinnan i samarbete med dietisten. Informationen ges då för det mesta både muntligt och skriftligt. Vidare visar resultatet att barnmorskorna anser att det är viktigt att ge kostråd till gravida kvinnor och att de allra flesta kvinnor får kostrådgivning på mödravårdscentralen. Barnmorskorna anser att de och den gravida kvinnan har ett gemensamt ansvar när det gäller information angående kost. Barnmorskorna grundar kostrådgivningen främst på Svenska Livsmedelsverkets rekommendationer och undersökningen visar att de informerar om det mesta som det Svenska Livsmedelsverket tar upp angående kost under graviditeten. Slutsatsen av denna undersökning är att barnmorskorna ger en individuellt anpassad kostrådgivning som följer det Svenska Livsmedelsverkets rekommendationer. / The aim of this study was to examine what view the midwives have on nutritional guidance towards pregnant women, if they give information regarding diets, and if so, how they inform pregnant women, and also what the information consists of. Furthermore, the aim of this study was to determine how the midwives comply with the recommendations given by the Swedish National Food Administration. A descriptive cross-sectional study was carried out among all midwives at the maternity clinics in the county of Uppsala. There were 36 midwives that participated in the study (53 %) which consisted of a web based questionnaire. The result of this study indicated that the midwives frequently give nutritional guidance to the pregnant woman in collaboration with the dietician. The pregnant woman often receives both verbal and written information. The results also indicate that the midwives believe that it is important to give nutritional guidance to pregnant women and that most of them get this guidance at the maternity clinic. The attitude of the midwives is that they, together with the pregnant woman, have a mutual responsibility when it comes to information about nutrition during pregnancy. The midwives nutritional guidance is based on the given recommendations of the Swedish National Food Administration, and the study also shows that the information given by the midwife corresponds with the information that the Swedish National Food Administration emphasise. Therefore the conclusion of this study is that the midwives give an individually adjusted nutritional guidance which corresponds to the recommendations given by the Swedish National Food Administration.

The purpose of this study was to assess nurse and medical assistant perceived needs prior to implementing an expended web-based training (WBT) program in physician clinics. This case study was conducted with a mixed-data approach using quantitative and descriptive survey data collection. A total of 239 nurses and medical assistants within the Trinity Mother Frances Hospitals and Clinics dispersed throughout east, north east and north central Texas participated. The participants shared knowledge and behaviors common to the culture of the organization. When new and existing clinical staff traveled to the distant primary campus for training, the operations of the clinic practice was disrupted. Employees are not hired in groups comprising convenient training class sizes, and mandatory training often cannot wait until a class is of a cost effective size. The data were collected using a 50-item survey evaluating computer access, computer usage, computer knowledge (satisfaction, frustration, and motivation to transfer learning), and WBT preference (employee's support and employee's perception of supervisor's support). Quantitative data were collected in the form of a dichotomous yes or no and ordinal data from two Likert type scales. Descriptive survey data was collected using open-ended questions emphasizing perceived strengths, weaknesses, opportunities and threats (SWOT) of WBT. Demographic data were collected to facilitate comparison of perspectives based on demographic information gathered. To support reliability and validity of the Clinic WBT Needs Assessment (CWBTNA), exploratory factor analysis, Cronbach's coefficient alpha, and correlations were utilized to validate the survey instrument. Chi-squares, ANOVAs, and t-tests were conducted. Following the Bonferroni control for Type I error rate (a), four t-test, two chi-squares, and three ANOVAs demonstrated significance. Descriptive responses generated from descriptive survey items were transcribed into an Excel spreadsheet which allowed coding and sorting. Themes consistent with order sets of the quantitative survey emerged. Among additional findings, statistical data demonstrated that staff perceived they transferred learning into the work place best when they perceived greater supervisor support. All findings are detailed in the document.

Anal cancer, like cervical cancer, is associated with Human Papillomavirus (HPV) infection. HIV+ patients have 38-60 fold increased risk of anal cancer compared to HIV- patients prompting many to suggest routine screening given the success of cervical Pap screening. Our goal is to describe our experience with routine anal Pap screening, determine which patients are most likely to have abnormal results, if anal disease on physical exam is predictive of cytology, and correlate cytology with histology findings. Charts of all patients with an anal Pap followed at the Hospital of Saint Raphael HIV Clinic were reviewed. Demographics, immune status, sexually transmitted disease history, cytology and histology data was extracted from medical charts. Patients with an anal Pap between November 1, 2002-November 30, 2004 were included. Those with an insufficient sample were excluded. Analysis was done using ÷2 for comparison of proportions and student t-test for continuous variables. Overall, 265/560 HIV+ patients had at least one anal Pap. Seventy-four of these 265 patients had an abnormal anal Pap. Mean age was 44 yrs, and 68% were men. Fifty-nine percent were African American, 34% White, and 17% Hispanic. Those with an abnormal Pap were more likely to be White (p=.03), and be gay or bisexual men (p=.02). They were also more likely to have lower CD4+ nadir (142 vs 223, p=.005) and CD4+ at time of anal Pap (353 vs 497, p<.001). Those with an abnormal anal Pap also had more anal disease (30% vs 9%, p<.001), history of warts (23% vs 12%, p=.02) and herpes (35% vs 22%, p=.02). Anal disease on physical exam had a sensitivity of 56% and specificity of 77% for abnormal cytology findings. On histology two patients had Anal Intraepithelial Neoplasia (AIN ) I, 2 AIN II, 3 AIN III, and 2 Squamous Cell Carcinoma In Situ. There was no correlation between cytology and histology. Routine anal cytology screening is a feasible tool to incorporate into an ethnically diverse HIV clinic for identifying precancerous anal lesions, a group which has been largely overlooked. Anal disease on physical exam is a poor predictor of abnormal cytology and there was no correlation between severity of disease on cytology and histology. However, further follow-up study is required to determine the impact on morbidity and mortality.

Syfte: Att testa den patientenkät som används i utvärdering av en leversjuksköterskemottagning på patienter med dekompenserad levercirros för att undersöka upplevelsen av att besvara frågorna samt frågornas relevans till patientens situation. Metod: Pilotstudiens metod var mixad. Resultat: Spridningen av deltagarnas upplevelse av oro/obehag av enkäten var stor (VAS 6-100 millimeter). Vid få sjukdomssymtom väcktes oro om framtida sjukdomsutveckling men vid längre tids sjukdom kändes samtliga symtom igen, tankar om tidigare beteende uppstod vid alkoholsorsakad sjukdom. En mindre spridning (VAS 66-92 millimeter) sågs gällande hur viktiga/väsentliga frågorna upplevdes. Frågor om bemötande ansågs viktiga och påverkade upplevelsen av rätten till vård. Kompletterande frågor om individuellt anpassad information samt upplevelsen av delaktighet vid information efterfrågades. Deltagarna visade hög uppskattning (VAS 73-95 millimeter) till att sjukdomen/situation uppmärksammades genom enkäten. Besöken till sjuksköterskan skiljde sig från läkarbesök. Sjuksköterskan fokuserade på egenvård och mer tid fanns för information. För en informant innebar försöksverksamheten ökade antal sjukhusbesök, samordning innebar för- och nackdelar. Vid symtom på fatigue och nedsatt koncentrationsförmåga upplevdes enkäten lång, tvådelad enkät efterfrågades. Vid lindrig sjukdom upplevdes enkäten inte ansträngande. Språket var enkelt att förstå och innehållet upplevdes relevant. De öppna frågeställningarna tillförde inte något för de tre informanterna. / Purpose: To test the patient questionnaire used in the evaluation of an intervention with nurse-led clinic for patients with decompensated liver cirrhosis to examine the experience of answering the questions as well as their relevance to the patient's situation. Method: The pilot study was conducted with a mixed method. Results: The variation of the participants' experience of anxiety/discomfort of the questionnaire was large (VAS 6-100 millimeters). Individuals with few disease symptoms had concerns about future development of the disease, in the case of long disease experience all the symptoms was familiar. Following alcohol induced disease thoughts of past behavior occurred. A smaller variation (VAS 66-92 millimeters) was seen regarding the experience of how important/essential the questions felt. Questions about treatment were considered important and affected the perception of care. Questions about individualized information was requested as well as the experience of participation in the exchange of information. The participants showed a high appreciation (VAS 73-95 millimeters) that the disease/situation was highlighted by the survey. The visits to the nurse differed from appointments to physicians. The nurse focused on self-care and more time was available for information. For one informant the intervention increased the total number of hospital visits, coordination meant advantages and disadvantages. Symptoms of fatigue and impaired concentration made the questionnaire experienced as too long, a two-parted questionnaire was requested, the size was not strain in mild disease. The language was easy to understand and the content perceived relevant. The open issues brought nothing for the three informants.

Acquired Immunodeficiency Syndrome (AIDS) is characterized by the progressive destruction of a person’s immune system and is the latest and most serious stage of Human Immunodeficiency Virus (HIV) infection. Botswana currently has the highest estimated prevalence of HIV infection in the world. Botswana has a relatively young population structure, with about 60% of the approximately 1,8 million people aged less than 45 years. HIV prevalence for pregnant women aged 15–45 years in Botswana did, however, decrease marginally from 36,2% in 2001 to 35,4% in 2002. It is estimated that about 258 000 Botswana are now living with HIV and AIDS, and high morbidity and mortality rates due to HIV/AIDS have seen Botswana slip down the United Nations Development Plan (UNDP) Human Development Index rankings from 71 in 1996, to 122 in 1999/2000. In 2002 Botswana initiated public antiretroviral therapy (ART) at four sites initially to provide treatment to HIV/AIDS patients before expanding the programme to the rest of the country. The specific objective of the study was to investigate the prescribing patterns of ARV drugs at Sekgoma Memorial Hospital ARV therapy clinic (SMH–IDCC) in the central district of Botswana for a two–year period from 2005 to 2006. Data from 1717 patients were obtained from the SMH–IDCC electronic database regarding ARV drugs prescribed during the study period, CD4–Tcell count (cells/?L) at the commencement of therapy and after six months from the commencement of therapy and side effects necessitating change of therapy for the study period 2005 until 2006. The study showed that there were eight antiretroviral therapy (ART) regimens prescribed: zidovudine plus lamivudine plus efavirenz (AZT/3TC/EFV), zidovudine plus lamivudine plus nevirapine (AZT/3TC/NVP), Combivir® plus efavirenz (CBV/EFV), Combivir® plus nelfinavir (CBV/NFV), Combivir® plus nevirapine (CBV/NVP), stavudine plus lamivudine plus efavirenz (D4T/3TC/EFV), stavudine plus lamivudine plus nelfinavir (D4T/3TC/NFV), and stavudine plus lamivudine plus nevirapine (D4T/3TC/NVP). The most prescribed ART regimen for adult patients was Combivir® plus efavirenz (CBV/EFV) (51,37%). This was broken down as 17,20% of females and 34,17% of males. The second most prescribed ART regimen was Combivir® plus nevirapine (CBV/NVP)(36% of the total study population (N=1717). This represented 34,17% of females and 1,98% of males. The most prescribed ART regimen in children was zidovudine plus lamivudine plus efavirenz (AZT/3TC/EFV) (3,73% of the total population), broken down as 1,05% of females and 2,68% of males. The second most prescribed regimen in this group was zidovudine plus lamivudine plus nevirapine (ZDV/3TC/NVP) (3,50% of total population). The findings from this study indicated that all eight the ART regimens prescribed at the study site were in accordance with the Botswana national ART guidelines. There were thirteen different types of side effects necessitating change of therapy, including pregnancy, treatment failure and poor adherence. The average CD4–Tcell count change (155.63 cells/?L, ± 204.08 cells/?L) for the study population was more than 100% after six months from commencement of therapy, indicating success of therapy in terms of CD4–Tcell count. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Acquired Immunodeficiency Syndrome (AIDS) is characterized by the progressive destruction of a person’s immune system and is the latest and most serious stage of Human Immunodeficiency Virus (HIV) infection. Botswana currently has the highest estimated prevalence of HIV infection in the world. Botswana has a relatively young population structure, with about 60% of the approximately 1,8 million people aged less than 45 years. HIV prevalence for pregnant women aged 15–45 years in Botswana did, however, decrease marginally from 36,2% in 2001 to 35,4% in 2002. It is estimated that about 258 000 Botswana are now living with HIV and AIDS, and high morbidity and mortality rates due to HIV/AIDS have seen Botswana slip down the United Nations Development Plan (UNDP) Human Development Index rankings from 71 in 1996, to 122 in 1999/2000. In 2002 Botswana initiated public antiretroviral therapy (ART) at four sites initially to provide treatment to HIV/AIDS patients before expanding the programme to the rest of the country. The specific objective of the study was to investigate the prescribing patterns of ARV drugs at Sekgoma Memorial Hospital ARV therapy clinic (SMH–IDCC) in the central district of Botswana for a two–year period from 2005 to 2006. Data from 1717 patients were obtained from the SMH–IDCC electronic database regarding ARV drugs prescribed during the study period, CD4–Tcell count (cells/?L) at the commencement of therapy and after six months from the commencement of therapy and side effects necessitating change of therapy for the study period 2005 until 2006. The study showed that there were eight antiretroviral therapy (ART) regimens prescribed: zidovudine plus lamivudine plus efavirenz (AZT/3TC/EFV), zidovudine plus lamivudine plus nevirapine (AZT/3TC/NVP), Combivir® plus efavirenz (CBV/EFV), Combivir® plus nelfinavir (CBV/NFV), Combivir® plus nevirapine (CBV/NVP), stavudine plus lamivudine plus efavirenz (D4T/3TC/EFV), stavudine plus lamivudine plus nelfinavir (D4T/3TC/NFV), and stavudine plus lamivudine plus nevirapine (D4T/3TC/NVP). The most prescribed ART regimen for adult patients was Combivir® plus efavirenz (CBV/EFV) (51,37%). This was broken down as 17,20% of females and 34,17% of males. The second most prescribed ART regimen was Combivir® plus nevirapine (CBV/NVP)(36% of the total study population (N=1717). This represented 34,17% of females and 1,98% of males. The most prescribed ART regimen in children was zidovudine plus lamivudine plus efavirenz (AZT/3TC/EFV) (3,73% of the total population), broken down as 1,05% of females and 2,68% of males. The second most prescribed regimen in this group was zidovudine plus lamivudine plus nevirapine (ZDV/3TC/NVP) (3,50% of total population). The findings from this study indicated that all eight the ART regimens prescribed at the study site were in accordance with the Botswana national ART guidelines. There were thirteen different types of side effects necessitating change of therapy, including pregnancy, treatment failure and poor adherence. The average CD4–Tcell count change (155.63 cells/?L, ± 204.08 cells/?L) for the study population was more than 100% after six months from commencement of therapy, indicating success of therapy in terms of CD4–Tcell count. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Bakgrund: Ohälsosamma levnadsvanor ökar i västvärlden och orsakar folksjukdomar så som hjärtkärlsjukdom, cancer, sjukdomar i andningsorganen och diabetes. Hälso- och sjukvården uppmanas att arbeta med förebyggande metoder mot användandet av alkohol och tobak, inaktivitet och ohälsosam kost. Det saknas aktuell forskning som rör distriktssköterskors hälsofrämjande arbete på livsstilsmottagning, därför behövs erfarenheterna undersökas för att utveckla det hälsofrämjande arbetet inom primärvården. Omvårdnadsteoretikern Dorothea Orens teori om egenvård belyser vikten av sjuksköterskans roll att stärka patientens kapacitet till att själv ta makten över sin hälsa. Syftet med studien var att undersöka distriktssköterskors erfarenhet av att arbeta hälsofrämjande på livsstilsmottagning. Metoden var kvalitativ med induktiv ansats där fem intervjuer gjordes med distriktssköterskor som arbetade på livsstilsmottagning förlagd på vårdcentral. Intervjuerna analyserades enligt Graneheim och Lundmans innehållsanalys. Resultatet visade två övergripande kategorier med fem underkategorier. Kategorin ”Barriärer i det hälsofrämjande arbetet” med underkategorierna ”Patientens nivå av hälsolitteracitet" och ”Patientens motstånd till egenvård” Den andra kategorin var ”Möjligheter med ett hälsofrämjande arbete” med underkategorierna ”Individanpassa arbetet”, ”följa upp patientens levnadsvanor” och ”Samverkan med andra hälsoyrken”. Slutsats: Dorothea Orems teori går att applicera i distriktssköterskornas hälsofrämjande arbete, men den visar samtidigt att hälsolitteraciteten har betydelse för att individanpassa arbetet.  Studiens resultat kan stödja liknande forskning för att skapa evidens.  Vidare forskning krävs för att undersöka om några verktyg används och i så fall, vilka verktyg och dess funktion för att utveckla strukturen i det hälsofrämjande arbetet på Livsstilsmottagning inom primärvården. / Background: Unhealthy lifestyles are increasing in the Western world, causing widespread diseases such as cardiovascular disease, cancer, respiratory diseases and diabetes. The health services are encouraged to work with preventive methods against the use of alcohol and tobacco, inactivity and unhealthy diet. There is no current research related to nurses' health promotion in lifestyle clinics, hence it’s necessary to explore the experience to enable development in the area of health promotion in primary care. Nursing theorist Dorothea Orem's theory of self-care highlights the importance of the nurse's role to strengthen the patient's capacity to self take control of their health. The purpose of this study was to investigate the nurses' experience of working in health promotion lifestyle clinic. The method was qualitative inductive approach where five interviews were conducted with district nurses who worked on lifestyle clinics located at the medical center. Interviews were analyzed according Graneheim and Lundman's content analysis. The results showed two main categories with five subcategories. Category "Barriers in health practice" with subcategories "The patient's level of health literacy" and "The patient's resistance to self-care" The other category was "Possibilities with a health promotion" with the categories “Adapt practice", "Monitor the patient's living habits" and "Collaboration with other health professions.” Conclusion: Dorothea Orem's theory can be applied in the district nurses' health practice work, but it also shows that of health literacy is important to individualize the work. The study results could support similar research to create evidence. Further research is needed to investigate if some tools are used and if so, which and its function in the structure of health promotion at lifestyle clinic in primary care.

Diante do enigma representado pelos alunos incluídos, sobretudo, aqueles com graves problemas psíquicos, ou com transtornos globais do desenvolvimento, o conhecimento do professor parece ser insuficiente. Na falta de beira do pedagógico, o discurso clínico é chamado a margear os processos de ensino e aprendizagem, sendo recorrente a desligitimação da escola como espaço potente e a indicação de práticas reeducativas. Que razões levam a escola a não reconhecer seu papel constitutivo? A educação, ao se ocupar dos que estão fora do ideal de normalidade, perdeu a referência de sujeito como uma trama enigmática? Trata-se de um estudo teórico, no qual essas questões são problematizadas a partir da experiência profissional da pesquisadora, das fontes primárias da educação especial (Relatórios de Jean Itard – 1901 – e Tratado médico filosófico sobre alienação mental ou mania – 1800 – de Phillip Pinel), do campo da psicopatologia médico-biológica e fundamental e do conto A terceira margem do rio, de Guimarães Rosa. Defendemos a partida de Itard como gesto capaz de partir áreas e instaurar um novo espaço-tempo, uma terceira margem, no que antes era dual. Educação – especial. O traço que une e separa, surge da aposta, do diagnóstico como margem, de Itard na transformação de Victor pela educação. Traço instaurador de uma área e de um sujeito, não guarda um sentido a priori. A fim de sublinhar a função constitutiva da escola e do professor, o traçado precisa deslizar do ideal de normalidade à pergunta pelas condições de possibilidade de uma educação, duvidando, suspendendo, verdades cristalizadas e empobrecedoras do humano. / Given the enigma represented by the students included, especially those with severe psychological problems, or with Global Development Disorders, the knowledge of the teachers seems to be insufficient. In the absence of pedagogical border, clinical discourse is called to do margin in the processes of teaching and learning, often not legitimating the school as potent and powerful space, and indication of re-educational practices. What reasons lead school not to recognize his role constitutive? The education, dealing with the "out of the ideal of normality", lost the individual as an enigmatic plot? It is a theoretical study, in which these issues are raised from the professional experience of the researcher, the primary sources of special education (Reports of Jean Itard- 1901- and A treatise on insanity and others disorders affecting the mind -1800- Philippe Pinel), the field of biological medical and fundamental psychopathology and from the tale called “A terceira margem do rio” (The third margin of the river) written by Guimarães Rosa. We advocate the departure of Itard as capable of break off areas and establish a new space-time, a third margin, in what used to be dual. Special – education. The lineament that unites and separates, arises from the investment, the diagnosis as margin, from Itard believing in Victor transformation through education. Lineament originator of an area and an individual, don't keep a sense a priori. In order to emphasis the constitutive function of the school and the teacher, the stroke need to slide off the ideal of normalcy to question the conditions of possibility of an education, doubting, suspending, petrified and depleting the human truths.