A rede embala e o ritmo da gestão embola / The net is cast and the management rhythm snags

Resumo Este artigo apresenta relato de experiência de uma pesquisadora e seu orientador no pós-doutorado sobre o viver dos acontecimentos no entorno da pesquisa, à luz de uma experiência que antecedeu tais acontecimentos. Traz transformações ocorridas anteriormente à criação do Sistema Único de Saúde (SUS) e durante o processo de sua implantação, incluindo o processo da Reforma Psiquiátrica a partir da nova legislação, que vinha contribuir no campo da desinstitucionalização. Mostra que a organização do Programa de Volta para Casa, implantação da portaria do Serviço Residencial Terapêutico, foi palco de protagonismo de diferentes atores e movimentos sociais vivenciados pela pesquisadora. Também esteve presente na gestão municipal em parceria e convênio de cogestão com uma fundação beneficente, para dar sustentação às transformações necessárias para o cuidado em liberdade nos serviços comunitários substitutivos às internações psiquiátricas, mesmo antes da lei que garantia o redirecionamento desse modelo. Assim, a partir desses lugares anteriores e do atual, busca-se olhar para o que foi construído nesses anos, as apostas feitas, os desafios enfrentados, as conquistas observadas. O risco eminente de retrocesso desse processo é o que motivou este registro em forma de relato de experiência, que busca um olhar após 15 anos de afastamento.

Abstract This article presents a researcher in post-doctoral internship and her advisor's experience report about the events around the research, oriented by an experience that happened before the events themselves. It brings transformations occurred before the establishment of the Brazilian National Health System (SUS) and during its implantation process, including the Psychiatric Reform process based on the new legislation, which contributed to the deinstitutionalization. It shows that the organization of the De Volta para Casa Program (Back Home Program) and the implementation of the Residential Therapeutic Service allowed for the protagonism of different actors and social movements lived by the researcher. She also integrated the municipal management as a partner and with a co-management agreement with a beneficent foundation to provide for the transformations needed for the outpatient care in community services to replace the psychiatric hospitalizations even before the law that guaranteed the redirection of this model. Hence, from these first places and from the current one, this paper aims to look at what was built in these years, the gambles made, the challenges faced, and the conquests observed. The eminent risk of a setback to this process is what motivated this record in the form of an experience report, which seeks an outlook after 15 years away.

A mediação em saúde: espaços e ações de profissionais na rede de atenção à população rural / Mediation in health: spaces and professional actions in the rural population care network

A atual organização das Redes de Atenção em Saúde (RAS) exige olhares que busquem analisá-las a partir dos profissionais e usuários que dão movimento a estes dispositivos. A mediação em saúde, enquanto uma ação do profissional em função das demandas de saúde do usuário e que intervém sobre seu fluxo de utilização dos serviços, é uma possibilidade de fazer esta análise. Tem-se como objetivo deste estudo analisar a organização local de uma RAS a partir da ação de mediação empreendida pelos profissionais que atuam nos serviços de saúde e que atendem populações rurais. Trata-se de um estudo qualitativo que se utilizou de entrevista semiestruturada, diário de campo e observação participante. Apreendeu-se que as ações de mediação em saúde, em seu exercício, envolvem diferentes setores e atores que incidem sobre o campo da saúde, gerando desacomodações em diferentes espaços, circunscrevendo-se além daquilo que é protocolizado e formalmente instituído para os serviços de saúde. O campo de atuação do mediador, no entanto, depende do reconhecimento das ações de mediação como uma atuação legítima, do contrário, existe a possibilidade de a ação de mediação gerar processos de desautorização e cerceamento dos profissionais. Apreendeu-se igualmente que, ao estudar a mediação em saúde em uma RAS, dá-se visibilidade a uma potência, que existe nas tramas destes arranjos, e isto merece atenção e mais debate, uma vez que impacta a lógica institucional e interfere sobre a organização da RAS localmente.

Abstract The current organization of Health Care Networks (Redes de Atenção em Saúde - RAS) requires a look that seeks to analyze them from the perspectives of professionals and users, which gives movement to these systems. The mediation in health, as an act of the professional on health demands of the users and affecting the flow of the use of the service, is one possibility to perform the RAS analysis. The objective of this study is to analyze the local organization of one RAS using the mediation activities undertaken by professionals working in health services and serving rural populations. This is a qualitative study that used semi-structured interview, field diary, and participatory observation. We learned that the exercise of mediation in health actions, involve different sectors and actors that happens on the health area, generating issues in different spaces and is limited beyond what is filed and formally instituted for health services. The playing field of the mediator, however, depends on the recognition of mediation actions as a legitimate action, otherwise there is a possibility that the action of mediation generates de-authorization and restriction processes to professionals. We also learned that by studying the mediation in health in one RAS gives visibility to the power that exists in the plots of these arrangements, that deserves attention and enlarged debate as it affects the institutional logic and interferes with the RAS organization locally.

Attention networks in benign epilepsy children with centrotemporal spikes / 中华神经科杂志

Objective To investigate the characteristics of attention networks impairment in benign epilepsy children with centrotemporal spikes.Methods The attention network test was performed in benign epilepsy children with centrotemporal spikes (n =75) and normal controls (n =75) on the efficiency of three anatomically defined attention networks:alerting,orienting,and execrtive control.Results The correct rate of attention network test was significantly lower in benign epilepsy children with centrotemporal spikes (95.77％ ± 5.63％) than that in normal controls (98.55％ ± 1.80％ ; t =4.063,P ＜ 0.05).The total average response time was significantly longer in benign epilepsy children with centrotemporal spikes ((946.87 ± 199.82) ms) than that in normal controls ((729.00 ± 146.75) ms ; t =-7.611,P ＜ 0.05).The orienting network effect (29 (12,56)ms) was lower in benign epilepsy children with centrotemporal spikes than in normal controls (51 (21,78) ms; Z =-2.771,P =0.006).The executive control network effect was higher in benign epilepsy children with centrotemporal spikes (80 (50,105) ms) than in normal controls (57 (25,88) ms; Z =-2.146,P =0.032).However,the difference in alerting network effects between the two groups was not statistically significant (P ＞ 0.05).Logistic regression analysis showed that the age on onset of the disease was an independent risk factor for the correct rate of attention network test and the total average response time (OR =1.830,95％ CI 1.193-2.807,P =0.006 ; OR =1.635,95％ CI 1.176-2.275,P =0.003).Conclusions The benign epilepsy children with centrotemporal spikes have impairment of attention networks.The age on onset of the disease has a significant impact on the attention of children with rolandic epilepsy.

Study of attention networks in hyperthyroid patients / 中华行为医学与脑科学杂志

Objective To investigate the characteristics and plausible mechanisms of attention network impairments in hyperthyroid patients.Methods 34 hypertyroid patients and 33 normal controls performed the attention network test (ANT),which was used for assessing three components of attentional networks including alerting,orienting,and executive control.Results The mean scores for alerting and orienting networks were significantly shorter (P ＜ 0.01) in hyperthyroid patients (respectively,(20.00 ± 22.47) ms,(35.26 ± 22.65) ms)than those in normal controls (respectively,(35.70 ± 17.62) ms,(50.61 ± 23.66) ms).The mean reaction time for executive control network was significantly longer(P ＜ 0.01) in hyperthyroid patients((116.71 ± 40.36)ms)than those in controls ((93.00 ± 29.34)ms).Triiodothyronine(T3) and thyroxine(T4) were positively correlated with the scores for executive control network (respectively,r=0.350,P＜ 0.05; r=0.417,P＜ 0.05) in hyperthyroid patients,whereas no relationship was found between thyroid stimulating hormone(TSH) and the value of executive control network.T3,T4 and TSH were not correlated with the value of alerting and orienting network in hyperthyroid patients.Conclusion Hypertyroid patients have extensive impairments in various kinds of attentional network,rather than a specific deficit.The recession of executive control network accompanies with enhancement of serum levels of T3,T4 in hyperthyroid patients.

The impact of long-term alcohol drinking heavily on the attention networks / 中国基层医药

Objective To explore the impact of alcohol to attention networks.Methods The attention network test was performed in 33 alcoholics and 27 normal controls on the efficiency of three anatomically defined attentional networks:alerting,orienting and executive control.Results The orienting network function was significantly lower(t =-3.72,P ＜0.01 ) in alcoholics (26.7 ± 38.6) ms than that in normal controls (51.8 ± 22.3 ) ms.The executive networks effects was higher and the alerting networks effects was lower in alcoholics than in normal controls,however without significant difference ( P ＞ 0.05 ).Conclusion The parietal lobe and cholinergic system may be more significantly affected by the alcohol.

Application and Analysis of Attention Network Test for Chinese Adult / 中国临床心理学杂志

Objective: The study has been testing the efficiency of attention networks in Chinese adults. Methods: The study has used "ANT" to examine 76 normal Chinese adults and analysed the effect on alerting, orienting and executive attention. Results: The reaction time across whole ANT is 502-940(706?105)ms, and the correct ratio is 93%-100%(0.97?0.07).The alerting effect is 30?20ms, orienting effect 51?24ms, and conflict effect 106?32ms. Correlation analyses demonstrate no correlation between alerting, orienting, and conflict resolution. Conclusion: ANT produces reliable subject estimates of alerting, orienting and executive attention function.