In an attempt to identify the best treatment for pregnant women with cardiac-valve prostheses who are receiving oral anticoagulants, we studied 72 pregnancies prospectively. In 23 pregnancies (Group I), the coumarin derivative acenocoumarol was discontinued and the patients received 5,000 U of subcutaneous heparin every 12 hours from the 6th to the 12th week of gestation, in 12 pregnancies (Group II), heparin was not substituted for the coumarin derivative until after the 7th week, and in 37 pregnancies, detected after the first trimester (Group III), the coumarin derivative was given throughout gestation. In most patients heparin was again substituted for the oral anticoagulant after the 38th week. Three mothers had thrombosis of a tilting-disk mitral prosthesis (two cases were fatal) during heparin treatment. No differences were found in the rates of spontaneous abortion in the three groups. Coumarin embryopathy occurred in 25 percent and 29.6 percent of the pregnancies in Groups II and III, respectively. We conclude that in the second and third trimesters of pregnancy, coumarin derivatives provide effective protection against thromboembolism while causing few fetopathic effects, but that these agents are contraindicated from the 6th to the 12th weeks of gestation. Low-dose heparin does not protect against prosthetic-valve thrombosis, and the possibility that a larger dose might be more effective requires further exploration.

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The Individualised Education Programme (IEP) is a fundamental document that describes all educational responses to the additional support needs of students, setting up the guideline for their learning and developmental experiences. Specifically, the IEP goals represent the personal destination translated into desirable behaviours and skills that will enable students with additional support needs to meet their educational and functional needs. This paper analysis the quality of the 2497 IEP goals established for 135 Portuguese students with additional support needs and their fit to the students' level of severity and educational level. The quality of IEP goals was measured using the Revised IFSP/IEP Goals and Objectives Rating Instrument and the content was categorised in reference to the International Classification of Functioning, Disability and Health, version for Children and Youth. Findings showed that goals are generally poorly written, particularly in terms of their measurability and that their quality decreases as students' progress in education. Results also showed that IEP goals for students with a highly individualised curriculum do not attend to their needs of more functional contents. The results are discussed in terms of their implications for teacher training.

Reduced speech fluency is frequent in clinical paediatric populations, an unexplained finding. To investigate age related effects on speech fluency variables, we analysed samples of narrative speech (picture description) of 308 healthy children, aged 5 to 17 years, and studied its relation with verbal fluency tasks. All studied measures showed significant developmental effects. Speech rate and verbal fluency scores increased, while pauses, repetitions and locution time declined with age. Speech rate correlated with semantic fluency tasks suggesting that it also depends upon the efficacy of lexical retrieval. These results indicate that the interpretation of disorders of speech fluency in childhood must incorporate age appropriate norms.

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