Background: Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. Adenomas can be precursors to CRC, and inflammatory bowel disease (IBD) can present with the same symptoms as CRC. The majority of patients with CRC initially consult primary care. Symptoms associated with CRC are also common among primary care patients, but seldom caused by any significant disease. Reliable diagnostic aids would be helpful in deciding which patients to refer. Faecal immunochemical tests (FITs) are commonly used for this purpose in primary care in Sweden, but there is little evidence to support this use. Faecal calprotectin (FC) has been suggested as an additional test. Aim: To explore how doctors in primary care investigate patients with suspected CRC, the value of FITs, symptoms and presence of anaemia in diagnosing CRC and adenomas in primary care, and whether FC tests could contribute to diagnosis. Methods: Three studies (1-3) were carried out in Region Jämtland Härjedalen, Sweden. There was no screening programme for CRC. We used a point of care qualitative dip-stick 3-sample FIT with a cut-off of 25-50μg haemoglobin/g faeces, and a calprotectin enzyme-linked immunosorbent assay (ELISA) test with a cut-off of 100 μg/g faeces. 1: A retrospective, population-based study including all patients diagnosed with CRC or adenomas with high-grade dysplasia (HGD) during the period 2005-2009 that initially consulted primary care. Symptoms, FIT results, anaemia and time to diagnosis were retrieved from medical records. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated from FIT results at the region’s health centres 2008- 2009. (Paper I.) 2: A prospective cohort study including consecutive patients where primary care doctors requested FITs and/or FC tests, at four health centres, from 30 Jan 2013 to 31 May 2014. FITs, FC tests, haemoglobin and iron deficiency tests were analysed; patients and doctors answered questionnaires about symptoms. Patients were examined with bowel imaging or followed for two years. Findings of CRC, adenomas with HGD, adenomas with low grade dysplasia (LGD) ≥1 cm and IBD were registered. (Papers II and III.) 3: A qualitative study of interviews with eleven primary care doctors. We explored what made them suspect CRC, and their practices regarding investigation and referral with particular attention to their use of FITs. Qualitative content analysis with an inductive approach was used for the analysis. (Paper IV.) Results: 1: Paper I: Of 495 patients 323 (65.3%) started the investigation in primary care. FITs were analysed in 215. In 23 cases with CRC, FITs were negative; 15 (65.2%) had anaemia. In 33 cases with CRC, FITs were performed due to asymptomatic anaemia; 10 (30.3%) had negative FITs. The time from start of investigation, to the diagnosis of CRC or adenomas with HGD, was significantly longer for patients with negative FITs. 2: 377 patients (9 diagnosed with CRC, 10 with IBD) were included. Paper II: Concordance of positive answers about symptoms from patients and doctors was generally low. Rectal bleeding (recorded by 43.5% of patients and 25.6% of doctors) was the only symptom related to CRC and IBD. The FIT showed a better PPV than rectal bleeding for CRC and IBD. When patients recorded rectal bleeding, the FIT had a PPV of 22.6% and a NPV of 98.9% for CRC and IBD. Paper III: The best test for detecting CRC and IBD was the combination of a positive FIT and/or anaemia with a sensitivity, specificity, PPV and NPV of 100%, 61.7%, 11.7% and 100% respectively. The FC test had no additional value to the FIT alone. The sensitivity, specificity, PPV and NPV of the FIT for CRC in study 1 was estimated at 88.4%, 73.3%, 6.2% and 99.7% respectively. In study 2, corresponding figures were 88.9%, 67.4%, 6.3% and 99.6% respectively. 3: Paper IV: We identified four categories: “Careful listening – with awareness of the pit-falls”, “tests can help – the FIT can also complicate the diagnosis”, “to refer or not to refer – safety margins are necessary”, and “growing more confident – but also more humble”. All doctors had found their own way to handle FIT results in the absence of guidelines. Conclusion: The diagnostic process when suspecting CRC can be described as navigating uncertain waters with safety margins. FITs were often used by primary care doctors but with considerable variations in interpretation and handling of results. Rectal bleeding was the only symptom related to CRC and IBD, but the FIT showed a better PPV than rectal bleeding. The combination of a negative FIT and no anaemia may be useful as a rule-out test when CRC is suspected in primary care, and this potentially also applies when patients present with rectal bleeding. Further studies are needed to confirm this and to determine the optimal FIT cut-off value for this use.

Made available in DSpace on 2016-04-27T18:47:15Z (GMT). No. of bitstreams: 1 Gustavo de Almeida Herrera.pdf: 1253578 bytes, checksum: 11236d741d6de95ebcd1b100b23e1063 (MD5) Previous issue date: 2014-08-14 / This work was performed at the Clinic of Cognitive Neurology, Faculty of Medicine Catanduva (SP), Brazil, and is a study of symptomatic manifestations with clinical relevance for the diagnosis and treatment of Alzheimer's disease (AD) and its implications subjective-social . Were evaluated individuals with the diagnosis of AD, vascular dementia (VD), frontotemporal dementia (FTD), and dementia with Lewy bodies disseminated (DCL). 867 individuals complaining of some disturbance of cognition were referred to the clinic and undergo an assessment, the data resulted from the analysis of the history obtained from these patients and their caregivers / family, clinical examination and comprehensive neurological and neuropsychological assessment. Patients with a diagnosis of dementia underwent a battery of tests that contained: complete blood count, fasting blood glucose, serum lipids, renal evaluation, heart, liver, lung and thyroid function, serum vitamin B12 and CT or MRI and nuclear magnetic skull. AD was diagnosed in 42.3% of cases, the DV in 15.6%; DFT at 2.8%, and 1.6% in DCL. The severity of dementia was considered mild in 71.4% of cases, moderate in 24.9% and severe in 3.7%. It was important in the diagnosis of AD at the beginning of the clinical, the onset of oblivion to recent events (96.5%) and did not contribute to the difficulty in finding the words (15%), disorientation in time and space (11, 4%), behavioral changes (16.3%), personality change (12%), depression (22.3%), hallucinations (8.5%), abnormal gait (13.9%), disorders Language (13.1%) and recognition disorder (14.2%). All symptoms and signs above were significant in the evolution of the clinical picture, but at this stage virtually all dementia symptoms overlap. In AD, the onset of symptoms was slowly progressive in 98.1%, and also slowly progressive evolution in 89.9%. The obtained Hachinski score was 0 to 4 in 73.6% of cases of AD. In these, the history of hypertension was obtained in 49.9%, of stroke by 0.5% and 31.6% in psychiatric. Urge the professional care giving for the elderly prepare to take account of the implications of subjective-social order, ie, reflect on the nature of the empirical material which comes to hand: eg., Of how that elderly person and family / caregiver often can manifest on a disease, in a non-accurate or not-consistent, can falter or contradict themselves in their answers, health professionals should be discerning enough to seek the proper interpretation to such speeches / Este estudo foi realizado no Ambulatório de Neurologia Cognitiva da Faculdade de Medicina de Catanduva (SP), Brasil, e se trata de um estudo das manifestações sintomáticas clínicas com relevância para o diagnóstico e tratamento da doença de Alzheimer (DA) e suas implicações subjetivo-sociais. Foram avaliados, indivíduos com o diagnóstico de DA, demência vascular (DV), demência frontotemporal (DFT) e demência com corpos de Lewy disseminados (DCL). 867 indivíduos com queixa de algum distúrbio da cognição foram encaminhados ao ambulatório e submetidos a uma avaliação, cujos dados resultaram da análise da história obtida com esses pacientes e seus cuidadores/familiares, exame clínico e neurológico e avaliação neuropsicológica abrangente. Os pacientes com o diagnóstico de demência foram submetidos a uma bateria de exames em que constavam: hemograma completo, glicemia de jejum, lípides séricos, avaliação renal, cardíaca, hepática, pulmonar e de função tireoidiana, dosagem de vitamina B12 e tomografia e ou ressonância nuclear magnética de crânio. A DA foi diagnosticada em 42,3% dos casos; a DV em 15,6%; a DFT em 2,8%; e a DCL em 1,6%. A intensidade de demência foi considerada leve em 71,4% dos casos; moderada em 24,9%; e grave em 3,7%. Foi importante, no diagnóstico de DA, no início do quadro clínico, o aparecimento de esquecimento para fatos recentes (96,5%); e não teve significância a dificuldade em encontrar as palavras (15%), desorientação temporal e espacial (11,4%), mudança de comportamento (16,3%), mudança de personalidade (12%), depressão (22,3%), alucinações (8,5%), alteração da marcha (13,9%), distúrbios de linguagem (13,1%) e distúrbio do reconhecimento (14,2%). Todos os sintomas e sinais acima tiveram significância na evolução do quadro clínico, mas nesta fase praticamente todos os sintomas de demência se superpõem. Na DA, o aparecimento dos sintomas foi lentamente progressivo em 98,1%; e a evolução também lentamente progressiva em 89,9%. O escore de Hachinski obtido foi de 0 a 4 em 73,6% dos casos da DA. Nestes, o antecedente de hipertensão arterial foi obtido em 49,9%; de acidente vascular encefálico em 0,5% e o psiquiátrico em 31,6%. Urge que o profissional que dá atendimento à pessoa idosa se prepare para ter em conta algumas implicações de ordem subjetivo-social, ou seja, refletir sobre a natureza do material empírico que lhe chega às mãos: por exemplo, de como a pessoa idosa e o familiar/cuidador, muitas vezes podem se manifestar, sobre uma doença, de forma não-precisa ou não-coerente, podendo vacilar ou contradizer-se em suas respostas, cabendo ao profissional ter discernimento suficiente para buscar a interpretação adequada a tais discursos

Made available in DSpace on 2014-12-17T14:46:47Z (GMT). No. of bitstreams: 1 RamonEAP_DISSERT.pdf: 1410551 bytes, checksum: dfe074204e595b296e1933aa794efa40 (MD5) Previous issue date: 2010-09-24 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The objective of this work - which is characterized analyze the search for symptomatic tuberculosis in practice and perspective of the Community Health Agent (ACS) in the districts of Natal. Methods: This is a cross-sectional study. The study population was 646 professionals, and conducted a probabilistic random sampling, stratified by districts. The data were collected from one instrument to collect data based on Primary Care Assesment Toll (PCAT) and analyzed by descriptive statistics. The sample consisted of ACS was 87% female. Among the study participants 58% completed high school and 120 months of exercise training (95% CI 111.9 to 129.5) on average. 90% were USF. The average follow-up of cases found were 2 cases of TB since the beginning of the career of the ACS and the last three years the average is presented in a case accompanied. The ACS received satisfactory ratings on the bond of trust with the user, so as access to homes in the community. The ACS reported for denying the fear of being positive result was the biggest reason for not performing the sputum. All units have a professional that responds to the Tuberculosis Control Program. Regarding the structural capacity of primary care settings for the diagnosis of TB, we observed satisfactory levels in different districts of pots for sputum collection, however, a point that deserves attention from managers is lack of materials for packaging sputum. Fear of positive result was one of the reasons for the refusal of sputum collection, followed by alcoholism. With regard to TB suspects, all responded that ACS always suspect when the user has TB coughs, but in all districts were noticed at low delivery of requests for applications for smear. BSR in TB control, is characterized in practice as a complex action goes beyond technical expertise and contact with the family that breaks with the Cartesian. The BSR is part of the ACS can perform them from the daily visits. We conclude that the ACS is difficult to achieve. This practice should not be the privilege of this actor, but the entire team of primary care. We must rethink the practices of TB care, seeing the health surveillance while aegis of the working process of primary care teams for early diagnosis and thereby reduce TB in communities / Uma das prioridades nas pol?ticas de controle da TB refere-se ao diagn?stico precoce da doen?a, nas visitas domiciliares dos Agentes Comunit?rios de Sa?de (ACS), em que se espera oportunamente a identifica??o dos Sintom?ticos Respirat?rios na comunidade. Assim, prop?s-se analisar a busca de sintom?ticos respirat?rios de tuberculose na pr?tica e perspectiva do Agente Comunit?rio de Sa?de nos distritos de Natal. Trata-se de um estudo de corte transversal, sendo realizado inqu?rito com os ACS do munic?pio de Natal/RN. A popula??o do estudo foi constitu?da por ACS inseridos nas Unidades B?sicas de Sa?de e Unidades Sa?de da Fam?lia totalizando 646 profissionais, sendo realizado amostragem de forma probabil?stica aleat?ria, estratificada por distritos, Utilizou-se instrumento de coleta de dados baseado no Primary care Assesment Toll, (PCAT), adaptado para aten??o ? TB por Ruffino-Netto e Villa (2009). O question?rio tem como marco te?rico os atributos da aten??o prim?ria, uma vez que os sistemas de sa?de que se baseiam nesses atributos apresentam-se com melhor desempenho. RESULTADOS: a amostra de ACS foi composta de 87% do sexo feminino. Quanto ao grau de forma??o, 58% conclu?ram o ensino m?dio, em que os ACS apresentaram em m?dia de 120 meses de exerc?cio profissional (IC 95% 111,9 129,5. 90% eram USF. A m?dia encontrada de acompanhamento de casos foi de 2 casos de TB desde o in?cio da carreira profissional do ACS e nos ?ltimos tr?s anos essa m?dia se apresenta de 1 caso acompanhado.Os ACS obtiveram ?ndices satisfat?rios quanto ao elo de confian?a com o usu?rio, assim como o acesso aos domic?lios na comunidade. Os ACS relataram para a recusa o medo do resultado ser positivo foi o maior motivo da n?o realiza??o da baciloscopia de escarro. A maioria dos ACS referiu que se sente preparado para orientar quanto ? coleta de escarro na comunidade. No que se refere ao acesso do usu?rio aos servi?os de sa?de, verificou-se proximidade dos domic?lios aos servi?os de sa?de, entretanto o tempo de espera para o atendimento ? longo. Todas as unidades possuem um profissional que responde pelo Programa de Controle da Tuberculose. Em rela??o a capacidade estrutural das unidades de aten??o prim?ria para o diagn?stico de TB, observou-se nos diferentes distritos n?veis satisfat?rios de potes para a coleta de escarro, no entanto, um ponto que merece aten??o por parte dos gestores ? falta de insumos para o acondicionamento do escarro. O medo do resultado positivo foi um dos motivos para a recusa da coleta do escarro, seguido do Alcoolismo. No que tange ? suspeita de TB, todos os ACS responderam que sempre suspeitam de TB quando o usu?rio apresenta tosse, por?m em todos os distritos foram verificados a baixa entrega de solicita??es de pedidos de baciloscopia. A BSR no controle da TB, caracteriza-se na pr?tica como uma a??o complexa vai al?m das habilidades t?cnicas e o contato com a fam?lia que rompe com o cartesianismo. A BSR ? papel do ACS, podendo realiz?-las a partir das visitas di?rias. Conclui-se que o ACS encontra dificuldades para a consecu??o. Essa pr?tica n?o deve ser privil?gio desse ator, mas de toda a equipe da aten??o b?sica. ? preciso repensar as pr?ticas de aten??o ? TB, vislumbrando a vigil?ncia em sa?de enquanto ?gide do processo de trabalho das equipes da aten??o b?sica, para o diagn?stico precoce e a redu??o da TB nas comunidades

This thesis is concerned with communication disability and possibilities its therapy by the help of augmentative and alternative communications methods. It describes basic forms disturbed communications possibility and their symptomology too. Further it is focusing on disorders of speech and communication, whichs are consequence of other different disorder, e.g . child's cerebral palsy, autism, sensuous infliction . This work is bent on methods of augmentative and alternative communication ( AAC), which are accessible in the Czech republic.Practical part is engaged on experiences of individual informants (parents which look after the child with disturbed communications ability) with augmentative and alternative communications systems. It deals with possibilities of the usage of AAK system and its benefit for children.

Abstract Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open surgery to exclude an abdominal aortic aneurysm from the circulation to avert a rupture. The aim of this thesis was to evaluate the early and mid-term results of EVAR using the Zenith® stent-graft (Cook Inc, Bloomington, IN, USA) in asymptomatic and symptomatic abdominal aortic aneurysm (AAA) patients in three Finnish university hospitals. Furthermore, the aim was to study whether preoperative embolization of the inferior mesenteric artery (IMA) before EVAR decreases the incidence of a type II endoleak or has an effect on the aneurysm sac shrinkage. Finally, the results after secondary interventions for a type II endoleak were evaluated. Two hundred six patients underwent elective endovascular repair of an intact AAA. The use of the Zenith® stent-graft was associated with good early and mid-term results. The thirty-day mortality rate (2.9%) was in accordance with other EVAR studies. Only one late aneurysm-related death occurred in this series, whilst no patients died of a late aneurysm rupture. No stent-graft migrations or fractures were observed. Endoleak, defined as persistent blood flow outside the graft and within the aneurysm sac, remains a long-term problem with EVAR. The overall endoleak incidence was 34.6%. A type II endoleak (retrograde perfusion via aortic side branches) occurred in 52 patients (25.4%). EVAR was performed for 14 patients with a symptomatic, unruptured AAA. The median delay from admission to intervention was 4 days. EVAR of a symptomatic, unruptured AAA was associated with a favourable outcome even in patients with a very high operative risk. There were no perioperative deaths. Altogether forty patients treated at Kuopio University Hospital had a patent IMA on preoperative computed tomography (CT) and were treated successfully with coil embolization before EVAR. Thirty-nine patients who underwent EVAR at Oulu University Hospital without preoperative embolization of a patent IMA served as a control group. Preoperative coil embolization of the IMA significantly reduced the incidence of type II endoleaks after EVAR, but the present study failed to show any influence on late postoperative aneurysm sac shrinkage. Overall, 14 patients underwent a secondary intervention to repair the type II endoleak. Ten patients had transarterial embolization and four patients had translumbar embolization. The results were unsatisfactory; clinical success after the first secondary intervention was achieved in only two patients in the transarterial embolization group and three patients in the translumbar embolization group. These results seem to favour direct translumbar embolization rather than transarterial embolization. In conclusion, EVAR with the Zenith® stent-graft is effective in excluding AAAs from the circulation and is associated with good mid-term results.

The thesis interprets the development of Foucault's thinking and within The Order of Things it subjects the whole concept of economy to critical reflection and defines the structure and dynamics on which the term is built. My work progresses from the abstract issue of Foucault's thinking to specific theories related to the topic. The first part is focused on the key changes and breaks across the author's thinking and work and forms the basis for a comparison of The Order of Things with a broader view of Foucault's thinking. Then I follow with economic theory basis in The Order of Things and define terms such as monetary theory, value theory, wealth analysis and other that are directly connected with economic issues. I focus on authors of economic theories who have influenced Foucault's thinking or are differently connected with my explication, e.g. Adam Smith, David Ricardo or Karl Marx. In the final part of the thesis I compare Foucault's thoughts and conclusions with the philosophy of Louis Althusser in his book Reading Capital which is based on Karl Marx's theories. The focus is mainly on the interpretation of modern episteme which is in The Order of Things directly related to the term of economy. I introduce common and different attributes of Althusser's and Foucault's thinking and present my...

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Profound pulpal anesthesia is not always adequate in mandibular teeth after the administration of local anesthesia, especially in the presence of irreversible pulpitis. Failure to achieve anesthesia has been seen in 30–80% of patients in teeth with a diagnosis of irreversible pulpitis. Onpharma™ developed an FDA-approved device that uses sodium bicarbonate to buffer a standard local anesthetic (LA) solution so that its pH may become closer to its pKa. Claims have been made that buffering a local anesthetic increases the anesthetic’s effect. Previous studies on the anesthetic efficacy of Onpharma’s Onset buffering system were inconclusive and may be dependent on the techniques used. Objectives: The aim of this study is to determine whether a buffered local anesthetic can lead to more profound and faster pulpal anesthesia in mandibular molars diagnosed with symptomatic irreversible pulpitis as compared to a standard, unbuffered local anesthetic. Materials and Methods: 40 total subjects completed the study. Screened and eligible subjects with a mandibular molar diagnosed with symptomatic irreversible pulpitis were randomly allocated into 2 groups so 1 group received a total of 3 cartridges of a standard, unbuffered 2% lidocaine with 1:100,000 epinephrine via inferior alveolar nerve block (IANB) followed by supplemental buccal and lingual infiltrations, while the other received the equivalent yet buffered formulation. An electronic pulp tester (EPT) was used to objectively determine baseline pulpal status of the affected tooth, followed by 2-minute interval testing following the administration of all local anesthesia. The onset of pulpal anesthesia was defined by the first of 2 consecutive EPT=80 readings, and the endodontic treatment could begin. Profound pulpal anesthesia was ultimately determined if the patient reported a comfortable pulpotomy as reflected on the Wong-Baker FACES Visual Analog Scale. Null Hypothesis 1: Subjects possessing mandibular molars diagnosed with symptomatic irreversible pulpitis will not achieve pulpal anesthesia more profoundly using buffered 2% lidocaine w/ 1:100,000 epinephrine in comparison to the standard, unbuffered anesthetic formulation. Null hypothesis 2: Subjects possessing mandibular molars diagnosed with symptomatic irreversible pulpitis will not achieve pulpal anesthesia faster using buffered 2% lidocaine w/ 1:100,000 epinephrine in comparison to the standard, unbuffered anesthetic formulation. Results: We observed a local anesthetic success rate of 45% in the buffered group, 70% in the unbuffered group, and ultimately 57.5% between both groups. The findings further indicate that the VAS scores after pulpotomy is significantly different between the 2 groups (p=0.019), with the unbuffered group having a more profound mean VAS score of 1.2 (as opposed to a buffered mean of 3.1). Regarding the time of onset for pulpal anesthesia, there was no statistically significant difference noted between the buffered and unbuffered groups. Conclusion: Based on the findings of this study, the null hypothesis 1 cannot be rejected since unbuffered 2% lidocaine with 1:100,000 epinephrine had a statistically significant increase in profound pulpal anesthesia compared to the buffered equivalent. The null hypothesis 2 cannot be rejected since there was no evidence of a significant difference in the time to pulpal anesthesia between the buffered and unbuffered groups.

The diploma thesis deals with the topic of special education. It deals with the definition of basic knowledge in interpersonal communication and speech development in general, and especially in symptomatic speech disorders in people with mental disabilities. In context of communication, it presents four language levels with focus on the pragmatic language and the social-use communication. This thesis connects knowledge of intact speech development with speech development in children with intellectual disabilities, and knowledge of the pragmatic language level with the specifics of pragmatics of people with intellectual disabilities. The research of this thesis is produced by the interpretation of the results obtained by using the evaluation material which was created for this thesis - it is based on theoretical knowledge and inspired by evaluation materials of other authors. The research surveys the level of pragmatic language as a social use of communication among people using residential social services, specifically one home for people with disabilities. The conclusion of the thesis is the evaluation of the partial parts of pragmatic language level in persons with intellectual disabilities and recommendations for practice in improving the deficiencies on this level. During the evaluation, it was...

Made available in DSpace on 2016-04-28T18:24:05Z (GMT). No. of bitstreams: 1 Anna Eliza Mattos Fongaro.pdf: 852604 bytes, checksum: b8a241723e44bd5f56845659f9d61d72 (MD5) Previous issue date: 2009-05-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Based on written work of children undergoing phonological therapy, the discussion about the symptom aims to stand away from the language conception as object of knowledge. Such a distance is justified by considering that the language is not consisted of positive units which could be apprehended by the individual through his or her perception and cognition (ANDRADE, 2003) Functioning of language (SAUSSURE. 1916), former to individual and element of the triadic relation: individual language-the other, is responsible for the capture of the individual, placing him in the function of the language and promoting its division into the writing and reading instance. Implying this individual of Psychoanalysis demands to approach the subjectification issue also under the sexualization view (DE LEMOS, 1998, 1999, 2002). In the accomplished analysis, the materialness of writing is highlighted; segmentation and trace are fundamental elements. The hypo segmentations in the analyzed writing pieces are understood as speech elements that are present at writing (ABAURRE, 2002), they are the outcome of blending orality and writing under Language control (BORGES, 2006) a well as the forgotten possibilities of such function (CARVALHO,1995). In regard to the trace of the letters, it is underlined the homographic mistakes which brings the child s name latent under the manifest chains of writing (BOSCO, 1995). These mistakes are the outcome of the Language and demonstrate the child s alienation. The reflection about the symptom implied in considering the particular way of interweavement of an individual with/by the Language. The individual s unawareness of the reason for the occurrences of his writing and the impossibility of change point out the implication of the hypothesis of unconscious introduced by Freud (LIER DEVITTO, 2006). The operations of repression focus on the (visual and sound) image of the letters, indicated by Pommier (1996) allowed thinking about the symptom as an interweavement point of the subjectification with the language and by the language throughout the Oedipus complex passage / Este trabalho aborda a escrita de crianças encaminhadas para terapia fonoaudiológica. O objetivo desta dissertação é discutir a natureza do sintoma, a partir de uma perspectiva teórica que toma distância da concepção de que a linguagem é objeto de conhecimento sobre o qual a criança atua. Para operar tal deslocamento foi encaminhada uma reflexão que considera a ordem própria da língua (SAUSSURE, 1916), e entende que a linguagem é anterior ao sujeito e responsável por sua captura e, conseqüentemente, por sua entrada no universo simbólico. A concepção de sujeito compatível com tal perspectiva é a de sujeito dividido entre a instância que escreve e a que lê. Implicar este sujeito da Psicanálise exige abordar a questão da subjetivação também do ponto de vista da sexuação (DE LEMOS, 1998,1999,2002). Na análise empreendida foram eleitos aspectos relativos à materialidade da escrita, a saber: segmentação e traçado. As hipossegmentações na escrita analisada são entendidas como elementos da fala que comparecem na escrita (ABAURRE, 2002), são efeitos do cruzamento oralidade e escrita sob o comando da Língua (BORGES, 2006) e possibilidades esquecidas deste funcionamento (CARVALHO,1995). Em relação ao traçado das letras, destacam-se os equívocos homográficos que trazem o nome da criança latente sob as cadeias manifestas da escrita (BOSCO, 1995). Estes equívocos são produtos da Língua e mostram a alienação da criança. A reflexão sobre o sintoma implicou considerar o modo particular de enlaçamento de um sujeito na/pela linguagem. O desconhecimento do sujeito sobre o porquê dos acontecimentos da sua escrita e a impossibilidade de mudança apontam para a implicação da hipótese do inconsciente introduzida por Freud (LIER DEVITTO, 2006). As operação de recalcamento que incidem sobre a imagem (visual e sonora) das letras, indicadas por Pommier (1996), permitiram pensar no sintoma como ponto de entrelaçamento do processo de subjetivação na linguagem e pela linguagem na passagem pelo complexo edipiano

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