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RESUMO Examina-se o emprego do conhecimento morfológico por crianças do 3º. ao 5º. ano do ensino fundamental, analisando a grafia de terminações (morfemas) pronunciadas da mesma maneira, mas escritas diferentemente. Quatro grupos foram formados: (a) uso indiscriminado das formas de grafar as respectivas terminações, sugerindo o reconhecimento das diversas formas de escrevê-las, sem decidir convenientemente entre as mesmas; (b) preferência por uma das formas de grafar a terminação; (c) uso preferencial de outra forma de grafar a terminação; d) grafia convencional dos morfemas e o uso de informação morfológica. Embora progrida com a escolaridade, o uso da informação morfológica para a escrita de morfemas homófonos mostrou-se tardio, não estando concluído ao término da escola primária.
ABSTRACT Brazilian 3rd to 5th grade children´s use of morphological knowledge in spelling word endings which are pronounced the same (morphemes), but spelled differently, was analyzed. Four groups were formed: (a) spelling patterns used indiscriminately, suggesting children knew the morphemes had different representations, but were unable to decide between alternative spellings; (b) higher average score on one spelling form; c) higher average score on the alternative spelling form; (d) appropriately spelling of the word endings, indicating the use of written morphology. Although spelling improved with schooling, the use of morphological knowledge to disambiguate alternative spellings of similar sounding word endings is a late acquisition, which is not even completed by the end of primary school.
RESUMO
BACKGROUND: Laboratory monitoring for toxicity among patients receiving antiretroviral therapy (ART) in less-developed settings is technically challenging and consumes significant resources. METHODS: We conducted a cohort study of the 1800 adult patients who initiated ART at the Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Haiti from 2003 to 2006, using baseline data to establish the prevalence and using follow-up data to establish the incidence of hepatitis, renal insufficiency, hyperglycemia, anemia, neutropenia, and thrombocytopenia. We determined how frequently routine (not symptom-driven) testing detected significant laboratory abnormalities and calculated the cost per disability-adjusted life year (DALY) averted by detection of these events in the asymptomatic stage, compared with a strategy of symptom-prompted testing only. RESULTS: Forty-eight patients (3.5%) had severe anemia at baseline testing and consequently did not receive zidovudine. Fifty-three patients receiving zidovudine therapy developed severe anemia during follow-up (incidence, 2.5 cases/100 person-years). Monitoring for asymptomatic anemia with hematocrit testing was cost-saving at baseline and had a cost-effectiveness ratio of US$317/DALY averted during follow-up; with a complete blood count, costs increased to US$1182 and $10,781/DALY averted, respectively. With glucose monitoring, 11 patients were diagnosed with new-onset hyperglycemia during follow-up (incidence, 0.7 cases/100 person-years), resulting in a cost-effectiveness ratio of US$9845 per DALY averted. Monitoring for asymptomatic hepatitis and renal insufficiency was expensive and rarely affected care. CONCLUSIONS: Resource-poor countries should select which laboratory tests to perform on the basis of the cost-effectiveness of each test. This will depend on the national ART drug regimen and the prevalence of other comorbidities. Routine monitoring with multitest hematological and chemistry panels is unlikely to be cost-effective.