Intervenciones de un psicólogo hospitalario en el ámbito de las técnicas de reproducción asistida / Interventions by a Hospital Psychologist in the Field of Assisted Reproductive Techniques

La ficción comparte cada día una frontera más difusa con la realidad. Las técnicas de reproducción humana asistida son un tipo de biotecnología que se hace realidad en los escenarios reales y ficcionales permitiéndoles a muchas personas cumplir su deseo de formar una familia. Sin embargo, tales técnicas no están libres de obstáculos, uno de ellos es la mismísima subjetividad humana como horizonte de decisiones bioéticas. La cuestión del vínculo biológico con la progenie es algo tan arraigado que dificulta pensar en vínculos filiales por fuera de la biología. A continuación, se analizarán dos capítulos de la serie "New Amsterdam" en los que se evidencia cómo los vínculos de parentesco se ven trastocados por la irrupción de las técnicas de reproducción asistida. Asimismo, observamos el impacto subjetivo que éstas generan en los personajes de la tira que son médicos, de diferentes especialidades, que se encuentran con dilemas bioéticos vinculados al comienzo de la vida. El encargado de intervenir en estos escenarios es el psicólogo de planta del Hospital "Iggy" quien a su vez tiene una pareja igualitaria y ha formado una familia con él. Estas dos intervenciones que hemos recortado de la serie muestran la operatorio del psicólogo tendientes a permitir un cambio en las posiciones iniciales enfrentadas y una solución satisfactoria para los implicados

Fiction shares a more diffuse border with reality every day. Assisted human reproduction techniques are a type of biotechnology that becomes a reality in real and fictional settings, allowing many people to fulfill their desire to start a family. However, such techniques are not free of obstacles, one of them is the very human subjectivity as a horizon of bioethical decisions. The question of the biological bond with progeny is something so ingrained that it is difficult to think of filial bonds outside of biology. Next, two chapters of the series "New Amsterdam" will be analyzed in which it is evident how kinship ties are disrupted by the irruption of assisted reproduction techniques. Likewise, we observe the subjective impact that these generate on the characters in the strip who are doctors, from different specialties, who encounter bioethical dilemmas linked to the beginning of life. The person in charge of intervening in these scenarios is the staff psychologist at Hospital "Iggy" who in turn has an equal partner and has formed a family with him. These two interventions that we have cut out of the series show the psychologist's operation tending to allow a change in the initial opposing positions and a satisfactory solution for those involved

O estágio de convivência em casos de adoção: uma compreensão fenomenológica / The stage of coexistence in cases of adoption: a phenomenological understanding / La etapa de convivencia en casos de adopción: una comprensión fenomenológica

Este artigo teórico possui como temática o estágio de convivência em casos de adoção, etapa obrigatória em lei na qual crianças aptas para adoção passam a conviver com candidatos habilitados para tal, visando discutir a filiação adotiva e como ela pode ocorrer nesse período. Legalmente, esse momento deve ser acompanhado por equipe psicossocial, sendo emitido parecer técnico sobre o caso. Mas, o que acontece nesse processo? O que deverá ser observado? Uma revisão bibliográfica em três Bancos de Dados concluiu que as produções sobre a temática são insipientes, especialmente do ponto de vista da Fenomenologia. Durante o estágio de convivência, é comum que os pretendentes a pais tentem agradar a criança ou temam sua história, bem como esta pode tentar agradar ou testar os limites. Acompanhar esse período e discutir essas questões possibilita que todos habitem esse lar e essas relações, contribuindo para maior segurança na concretização da adoção.

This theoretical article has as its theme the stage of cohabitation in cases of adoption, a mandatory step in law in which children suitable for adoption pass to live with qualified candidates. It aimed to discuss adoptive filiation and how it occurs in the stage of cohabitation. Legally, this moment must be accompanied by psychosocial team that delivers technical opinion about it. But what happens in this process? What should be observed? A bibliographical review in three Databases concluded that productions on the subject are insipient, especially from the point of view of the Phenomenology. During the cohabitation stage, it's common for parents to try to please the child, or to fear their history, as well as the child try to please or to test limits. Following this period and discussing these issues enables everyone to inhabit this home and these relationships, contributing to greater security in the adoption implementation.

Este artículo teórico posee como temática la etapa de convivencia en casos de adopción, etapa obligatoria en ley en la que niños aptos para la adopción pasan a convivir con candidatos habilitados para tal, buscando discutir la afiliación adoptiva y cómo puede ocurrir en ese período. Legalmente, ese momento debe ser acompañado por equipo psicosocial, siendo emitido dictamen técnico sobre el caso. Pero, ¿qué sucede en este proceso? ¿Qué debe observarse? Una revisión bibliográfica en tres Bases de datos concluyó que las producciones sobre la temática son insípidas, especialmente desde el punto de vista de la Fenomenología. Durante la etapa de convivencia, es común que los pretendientes a padres traten de agradar al niño o teman su historia, así como ésta puede tratar de agradar o probar los límites. Acompañar ese período y discutir esas cuestiones posibilita que todos habite ese hogar y esas relaciones, contribuyendo para mayor seguridad en la concreción de la adopción.

La afiliación al sistema de salud de personas migrantes venezolanas en Colombia / The Affiliation to the Health System among Venezuelan Migrants in Colombia

Resumen: Introducción:El acceso de las personas migrantes venezolanas al sistema de salud es fundamental para su supervivencia y bienestar futuro. El objetivo de esta investigación es analizar los niveles de afiliación a dicho sistema de las personas venezolanas en las áreas urbanas de Colombia por periodos de arribo, así como los factores sociodemográficos y laborales asociados. Metodología: Se realiza análisis cuantitativo de tipo estadístico descriptivo e inferencial, a partir de la Gran Encuesta Integrada de Hogares 2018, la cual aporta datos representativos para Colombia y sus 13 ciudades más importantes. Se utilizan los módulos de migración, de variables sociodemográficas del hogar y de ocupación relativos a la población de 14 a 65 años. Resultados:Únicamente 24,5 % de dichos migrantes están inscritos al sistema de salud en contraste a 93 % de las personas colombianas. Los niveles de afiliación se redujeron de 82 % entre las personas venezolanos que arribaron en 2013 o antes a 10 % entre los que llegaron en 2017-2018. Las personas venezolanas afiliadas al sistema de salud son una población selecta en términos sociodemográficos; más joven, más educada, con mayor participación laboral y mayores ingresos que la población nativa en Colombia. La baja inserción de las personas migrantes venezolanas en empleos con contrato escrito restringe dicha afiliación. Conclusiones: Las personas venezolanas en Colombia tienen muy limitada la inscripción al sistema de salud. A pesar de que este es un derecho protegido por los marcos jurídicos internacional y nacional, estas personas enfrentan barreras económicas, políticas y sociales para ejercer ese derecho en Colombia.

Abstract: Introduction: Venezuelan migrants' access to the health system is fundamental to their survival and future well-being. This article aims to analyze the level of affiliation to the health care system of these migrants in the urban areas in Colombia by arrival periods and the associated sociodemographic and labor factors. Methodology: To this end, quantitative analysis is done based on descriptive and inferential statistical analyses of the 2018 Gran Encuesta Integrada de Hogares, which is a representative survey for Colombia and its 13 more important urban areas. We use the modules on migration, sociodemographic variables of the household and occupation relative to the population aged 14 to 65. Results: Only 24,5% of Venezuelan migrants are affiliated with any health care provider in contrast to 93% of Colombians. The levels of affiliation diminished from 82% among Venezuelans who arrived in 2013 or before to 10% among Venezuelans who arrived in 2017-2018. Venezuelans registered in the health system are a select population in sociodemographic terms; younger, more educated, with more labor participation and higher income than the native population in Colombia. The low insertion of Venezuelan immigrants in jobs with a written contract restricts this enrollment. Conclusions:The Venezuelans in Colombia have a very limited affiliation with the health system. Even though this is a right protected by international and national legal frameworks, Venezuelans encounter economic, political, and social barriers to exercise it in Colombia.

Interpretation and Suggestions of Notice on Standardizing the Allocation and Use of Licensed Pharmacists in Drug Retail Enterprises and Related Documents / 中国药房

OBJECTIVE：To unscramble the Notice on Standardizing the Allocation and Use of Licensed Pharmacists in Drug Retail Enterprises （called Notice for short ）and related document ，and to give some suggestions to provide reference for the industry and policy decision departments. METHODS ：The background and content of Notice were described briefly ；the problemsexisting in the corresponding provincial differentiated allocation policy and the difficulties existing in the implementation were analyzed to give some relevant suggestions. RESULTS & CONCLUSIONS ：The main contents of Notice contained adhering to the policy of licensed pharmacists ，steadily improving the allocation level of licensed pharmacists ，refining and implementing the allocation requirements ，and strengthening the implementation of supervision and inspection responsibilities ；giving full play to the role of licensed pharmacists and continuously strengthening the team building. At present ，drug administrations of many provinces in China have issued specific policies on the differentiated allocation of licensed pharmacists and pharmaceutical technicians ，which are mainly divided into four schemes. The author believes that the classification method of drug retail enterprises implemented in Shandong and Guangdong provinces are the most scientific. The implementation of differentiated allocation of pharmacists with health（pharmacy）professional title in drug retail enterprises can alleviate the problem of insufficient licensed pharmacists to a certain extent ，but the disadvantage is that it can not achieve accurate registration and control as well as the management of licensed pharmacists ，which is easy to produce policy gaps ；after the “affiliation licensed pharmacist ’s certificate ”phenomenon， the“certificate affiliation of pharmacist with health （pharmacy）professional title ”phenomenon appeared. It is suggested that the provincial drug supervision and administration departments should try the differentiated allocation scheme of hierarchical management；learn from the management experience of licensed pharmacists and pharmaceutical technicians in Guangdong province， develop relevant platforms to manage the information of pharmaceutical technicians uniformly ； strengthen the communication and interaction with the health and human resource security department as well as the mutual promotion mechanism of personnel information screening ，so as to solve the core bottleneck of licensed pharmacists ’quality.

Adoção tardia, filiação e devolução de crianças: uma realidade brasileira / Adopción tardía, filiación y devolución de niños: una realidad brasileña / Late adoption, filiation, and children devolution: a Brazilian reality / Adoption tardive, filiation et retour des enfants: une réalité brésilienne

O artigo trata da questão da adoção a partir da experiência de uma das autoras no Tribunal de Justiça do Rio de Janeiro. Apresenta as formas de adoção brasileiras, algumas em conformidade com as leis, outras realizadas de maneira informal. Examina as vicissitudes da adoção, entre as quais os casos de devolução. Procura, em seguida discutir suas consequências para o psiquismo, baseando-se nas interrogações sobre a filiação feitas pela psicanálise. Conclui com fragmentos da clínica, em que se trata de escutar os envolvidos ­trabalho a ser feito pela equipe de profissionais ­no intuito de facilitar caminhos pelos quais o sujeito venha a fazer para si um lugar e se exercer como sujeito de desejo

El artículo aborda el tema de la adopción a partir de la experiencia de una de las autoras en el Tribunal de Justicia de Rio de Janeiro. Presenta las formas de adopción brasileñas, algunas de acuerdo con las leyes, otras hechas de manera informal. Examina las vicisitudesde la adopción, incluso los casos de devolución. En seguida, busca discutir sus consecuencias para el psiquismo, basándose en las preguntas sobre la filiación planteadas por el psicoanálisis. Concluye con fragmentos de la clínica, en la cual se trata de escuchar a los implicados ­trabajo que debe realizar el equipe de profesionales ­para facilitar que lo sujeto venga a hacerse un lugar y se ejercer como sujeto de deseo

The article deals with the issue of adoption from the experience of one of the authors in the Court of Justice of Rio de Janeiro. It presents the Brazilian forms of adoption, some in accordance with the laws, others made informally. It examines the vicissitudes of adoption, including the cases of devolution. It then seeks to discuss its consequences for the psychism, based on the process of filiation as it is discussed by psychoanalysis. It concludes, using fragments of the clinic, in which it is about listening to those involved ­work to be done by the team of professionals ­,to facilitate the ways through which the subject will make himself a place and exercise himself as a subject of desire

L'article examine la question de l'adoption sur la base de l'expérience de l'un des auteurs de la Cour de Justice de Rio de Janeiro. Il présente les formes d'adoption brésilienne, certaines conformes aux lois, d'autres réalisées de manière informelle. Il examine les vicissitudes de l'adoption, y compris les cas de dévolution. Ensuite, il cherche à discuter ses conséquences sur le psychisme, à partir des questions d'affiliation posées par la psychanalyse. Il conclut, à partir de fragments de la clinique, qu'il s'agit d'écouter les personnes impliquées -travail à faire par l'équipe de professionnels -, facilitant ainsi les manières dont le sujet puisse faire un lieu pour soi et pour s'exercer en tant que sujet du désir

Falhas no reconhecimento da alteridade nos casos de devolução em adoções tardias / La non-reconnaissance de l'altérité dans les cas d'interruption en adoption tardive / No reconocer la alteridad en casos de interrupción en adopciones tardías / Failed recognition of otherness in cases of disruptions in late adoptions

Resumo Este estudo é parte de uma ampla investigação sobre vivência do processo de adoção malsucedida de crianças e adolescentes sob a perspectiva dos adotantes. Foi realizada uma pesquisa qualitativa, com base em entrevistas semiestruturadas com 11 sujeitos independentes, nove mulheres e dois homens, moradores de diferentes estados do Brasil, que passaram por adoções malsucedidas. Neste trabalho, buscamos investigar as falhas no reconhecimento da alteridade do filho, vivenciadas no período do estágio de convivência, nos casos de devolução na adoção. Foi comum, entre os participantes, a busca por uma explicação psicopatológica para os comportamentos considerados ruins da criança/adolescente. Ficou evidente a necessidade de maior investimento afetivo-emocional nos períodos iniciais do estabelecimento do vínculo parento-filial, para o acolhimento da criança/adolescente em sua totalidade e individualidade.

Résumé Cette étude découle d'une recherche approfondie sur l'expérience des adoptions infructueuses d'enfants et d'adolescents du point de vue des adoptants. Axé sur une approche qualitative, on a mené des entretiens semi-structurés avec 11 sujets indépendants (neuf femmes et deux hommes), habitant dans différents États du Brésil, qui ont vécu des adoptions infructueuses. La recherche s'intéresse à l'échec de la reconnaissance de l'altérité de l'enfant, vécues pendant la phase de coexistence, dans les cas d'interruption de l'adoption. Il était courant, chez les participants, la recherche d'une explication psychopathologique aux comportements dit mauvais de l'enfant/adolescent. Les résultats montrent la nécessité d'un plus grand investissement émotionnel-affectif dans les périodes initiales d'établissement du lien parent-enfant, pour accueillir l'enfant/adolescent dans son intégralité et son individualité.

Resumen El presente estudio es parte de una extensa investigación sobre la experiencia del proceso fallido de adopción de niños, niñas y adolescentes desde la perspectiva de los adoptantes. Se realizó una investigación cualitativa, basada en entrevistas semiestructuradas con 11 sujetos independientes, nueve mujeres y dos hombres, residentes en diferentes estados de Brasil, que tuvieron adopciones fallidas. En este trabajo se busca investigar las fallas en el reconocimiento de la alteridad del niño, vividas durante el período de la etapa de convivencia, en los casos de devolución en adopción. Entre los participantes, fue común la búsqueda de una explicación psicopatológica de los comportamientos considerados malos por el niño / adolescente. Era evidente la necesidad de una mayor inversión afectivo-emocional en los períodos iniciales de establecimiento del vínculo pariente-hijo, para acoger al niño / adolescente en su totalidad e individualidad.

Abstract This study derives from a broader investigation on the experience of unsuccessful adoptions of children and adolescents from the adopters' perspective. Based on a qualitative approach, we conducted semi-structured interviews with 11 independent subjects (nine women and two men), living in different states of Brazil, who experienced unsuccessful adoptions. The research investigates the failure in recognizing the child's alterity, experienced during the cohabitation stage, in cases of disruptions. Common among the participants was the search for a psychopathological explanation for the child/adolescent's supposed bad behaviors. Results show the need for greater emotional-affective investment in the initial periods of establishing the parent-child bond, to welcome the child/adolescent in their totality and individuality.

A construção do vínculo parento-filial no processo de adoção tardia: uma revisão integrativa / Building parent-child bonds in the late adoption process: a integrative review

O artigo tem por objetivo investigar os desafios e as motivações durante o processo de adoção tardia, assim como a influência desses fatores na construção do vínculo parento-filial. Foi realizada uma revisão integrativa da literatura, por meio de consulta bases de dados virtuais PubMed, BVS, Scopus, Scielo e PsycINFO. Após a aplicação dos critérios de inclusão e exclusão, restaram quatro estudos para análise. Os principais resultados indicam que os pais sentem ansiedade durante o processo de adoção, temem que a criança possa não se sentir pertencente à família e percebem preconceito por parte da família e dos amigos. Ter condição de infertilidade, ser um casal homoparental e desempenhar o papel de cuidador foram as principais motivações para a adoção tardia. Observou-se que a demora dos processos judiciais impacta negativamente o desenvolvimento do vínculo parento-filial, gerando sentimento de desamparo, insegurança e ansiedade nos pais e hostilidade associada ao medo de abandono nas crianças

This article aims to investigate the challenges and motivations during the late adoption process, as well as the influence of these factors on the construction of the parent-child bond. An integrative literature review was performed by consulting PubMed, VHL, Scopus, Scielo and PsycINFO virtual databases. After applying the inclusion and exclusion criteria, four studies remained for analysis. The main results indicate that parents feel anxiety during the adoption process, fear that the child may not feel belonging to the family and perceive prejudice from family and friends. Being infertility, being a homoparental couple and playing the role of caregiver were the main motivations for late adoption. Delayed legal proceedings have a negative impact on the development of the parent-child bond, generating feelings of helplessness, insecurity and anxiety in parents and hostility associated with the fear of abandonment in children

Adoção: políticas para a infância e juventude no Brasil? / Adoption: policies for children and youth in Brazil? / Adopción: ¿políticas para niños y jóvenes en Brasil?

Resumo Este artigo tem por objetivo refletir sobre a Lei 13.509/17 que dispõe sobre adoção e altera a Lei 8.069/90 (Estatuto da Criança e do Adolescente). Desejo entender quais os sentidos sobre adoção, filiação, exercício parental, famílias, práticas de justiça e políticas públicas que organizaram a promulgação desta lei. Em que medida a filiação adotiva pode estar sendo contemplada como uma política pública para a infância e a juventude? Será que a aposta na diminuição do tempo de um processo pode estar conectada à ideia de que adoção é solução do problema de crianças e jovens que são, em caráter protetivo, afastados de suas famílias de origem? Almejo analisar estas questões a partir do texto da lei, bem como por meio de debates públicos em revistas, jornais e outras mídias sobre o tema emitidos por profissionais ligados à Justiça da Infância e da Juventude.

Abstract This academic article aims to discuss the Law 13,509/17, which provides for adoption and amends the Law 8.069/90 (also known as "Statute of the Children and the Adolescents"). My goal is to understand the meanings associated with adoption, parental exercise, families, justice practices and public policies (related to the referred Law's promulgation). How can an adoptive filiation be considered a public policy for children? May the time reduction of a process be connected to the idea of an adoption as a solution for children's issues in a protective way, as these ones are away from their families of origin? This piece aims to analyze these issues according to the Law's perspective, as well as through public debates on the subject, disclosed by professionals related to the Justice of Childhood and Youth (sources: magazines, newspapers and other media).

Resumen Este artículo tiene como objetivo reflexionar sobre la Ley 13.509/17, que establece la adopción y modifica la Ley 8.069/90 (Estatuto da Criança e do Adolescente). Quiero entender cuáles son los significados de adopción, afiliación, crianza de los hijos, familias, prácticas de justicia y políticas públicas que se han organizado para promulgar esta Ley. ¿En qué medida se puede contemplar la membresía como una política pública para la infancia y la juventud? ¿Podría la apuesta por reducir el tiempo de un proceso estar relacionada con la idea de que la adopción es una solución al problema de los niños y jóvenes que, de manera protectora, son retirados de sus familias de origen? Mi objetivo es analizar estos temas a partir del texto de la Ley, así como a través de debates públicos sobre el tema en revistas, periódicos y otros medios emitidos por profesionales vinculados a la Justicia de la Infancia y la Juventud.

O brincar na relação parento-filial: um recurso de integração da filiação adoltiva / Play and adoptive filiation: process of integration of the paradoxical family identity / Juego y filición adoptiva: processo de integration de la identidad familiar paradoxal

O trabalho discute o brincar como elemento significativo no processo de constituição da filiação adotiva, na perspectiva de pais e mães adotivos. Pensou-se a presença dos fenômenos transicionais, vividos nos jogos e nas brincadeiras entre pais e filhos, como recurso psíquico para a integração da identidade paradoxal da família adotiva. Este estudo faz parte de uma ampla pesquisa qualitativa sobre parentalidade e filiação adotivas, na qual realizamos entrevistas semiestruturadas, com 14 mães e 10 pais adotivos. Os dados obtidos foram analisados pelo método de análise de conteúdo de Bardin no modelo categorial. Observou-se que brincar foi valorizado pelos pais como indicador da boa qualidade relacional com os filhos. Os participantes expressam que, por meio das brincadeiras, eles e seus filhos compartilharam conteúdos internos, desenvolvendo uma intimidade e criando espaço para experimentarem juntos dilemas em torno do paradoxo da filiação adotiva e do enigma sobre as origens (AU).

The work discuss playing as a significant element in the process of adoptive filiation constitution, from the perspective of foster parents. It was intended to think the presence of the transitional phenomena, lived in the games and in the playing moments involving parents and children, as a psychic resource for the integration of the paradoxical identity of the adoptive family. This study is part of an extensive qualitative research on parenting and adoptive filiation, in which we conducted semistructured interviews with 14 mothers and 10 adoptive parents. The data obtained were analyzed by the Bardin content analysis method in the categorical model. It was observed that playing was valued by parents as an indicator of good relational quality with their children. Participants express that through play they and their children shared internal content developing an intimacy, creating space to experiment together dilemmas around the paradox of adoptive filiation and the enigma about origins (AU).

El trabajo discute el lugar del juego como elemento significativo en el proceso de constitución de la filiación adoptiva, desde la perspectiva de los padres y madres adoptivos. Fueron pensados los fenómenos transicionales, vivenciados en el juego entre padres e hijos, como recurso psíquico en la integración de la identidad paradoxal de la familia adoptiva. Este estudio es parte de una amplia investigación cualitativa sobre parentalidad y filiación adoptiva, en la cual fueron realizadas entrevistas semiestructuradas con 14 madres y 10 padres. Los resultados obtenidos fueron analizados según el método de análisis de contenido de Bardin, en el modelo categorial. Fue observado que el jugar fue valorado por los padres como indicador de buena calidad relacional con los hijos. Los participantes expresan que, a través del juego, ellos y sus hijos compartieron contenidos internos desarrollando intimidad y creando espacio para experimentar juntos algunos dilemas en torno del paradojo de la filiación adoptiva y el enigma sobre el origen (AU)

Associação político-partidária e influência da estrutura de incentivos na adesão dos municípios às políticas de saúde: evidências do Projeto Mais Médicos para o Brasil / Political partisanship and influence from the funding structure on the adhesion of municipalities to health policies: evidence from the project Mais Médicos para o Brasil

O projeto Mais Médicos para o Brasil é uma ação do programa Mais Médicos, formulada pelo governo federal e implementada pelos municípios brasileiros a partir de 2013. Sua finalidade é levar médicos brasileiros e estrangeiros para regiões onde faltam esses profissionais. O estudo investiga se há associação político-partidária e influência da estrutura de incentivos na decisão dos municípios em aderir ao projeto. Para tanto, utiliza dados de adesão dos municípios em função da filiação partidária dos prefeitos e realiza entrevistas com secretários de saúde de dois municípios selecionados da região de saúde de Limeira, no estado de São Paulo. Os resultados sugerem haver tanto associação político-partidária como influência da estrutura de incentivos. Conclui-se que mesmo em países federativos e com marcadas desigualdades regionais, políticas públicas nacionais que demandam cooperação de diferentes esferas de governo podem ser implementadas com relativo sucesso, desde que uma estrutura apropriada de incentivos tenha sido prevista na formulação da política.(AU)

The project Mais Médicos para o Brasil (More Doctors for Brazil) is an action of the program Mais Médicos, created by the Brazilian federal government and implemented by the Brazilian municipalities starting in 2013. The goal of the program is to provide Brazilian and foreign doctors to regions of the country where these professionals are lacking. This study investigates if political partisanship and the funding structure have influence in the decision of municipalities to join the project. For such, this study uses data of adhesion from municipalities depending on the party affiliation of mayors and conducts interviews with health secretaries from two municipalities selected in the region of Limeira in the state of São Paulo, Brazil. The results suggest that both political partisanship and the funding structure have influence. This study concludes that even in federated countries marked by regional differences, national public policies that require cooperation from different government levels can be implemented with relative success, as long as a proper funding structure is designed during the formulation of the policy.(AU)

An analysis on formation mechanism and balance affiliation between health insurance payment standard and market price / 中国卫生政策研究

At present,because market price survey and health insurance payment standard adjustment mechanism in china is incomplete,health insurance payment standard can not be completely equivalent to the actual market price of drugs. This paper analyzed and summarized the main factors affecting the balance and formation mechanisms under differ-ent medical insurance payment standard policies. It is found that the balance formation mechanism depends not only on the reimbursement ratio of drugs,but also on the development pattern of the payment standard and on the source of the refer-ence price system selected. On the issue of the ownership of the balance,from the specific practices of pilot cities such as Chongqing and Shaoxing,it can be seen that the merits and demerits still exist to the medical institutions for internal de-velopment models or re-allocated by the government agencies'performance-based. Compared with the simple balance reten-tion model,the redistribution model can enhance the service of medical institutions by regulating their behavior. However, medical institutions may provide false data to get more balance in the redistribution model,and game theory was used to reduce the policy risk of misreporting the private balance of data from medical institutions,and the analysis of strategic choices of medical institutions and supervisory departments Finally,"three-step"policy proposal was proposed on the issue of balance attribution. In the short term,the balance should be given to the medical institutions to increase their bargaining motivation. At the same time,the performance appraisal and supervision methods should be explored to enhance the feasi-bility of redistribution model. In the long run,the balance should be eliminated gradually through the improvement of mar-ket price survey and medical insurance payment standard adjustment mechanism.

Religiosidad juvenil y su asociación a comportamientos sexuales en adolescentes consultantes en un centro de salud sexual y reproductiva en la Región Metropolitana / Youth religiosity and its association to sexual behaviors in adolescent consultants in a sexual and reproductive health center in the Metropolitan Region

ANTECEDENTES: La evidencia muestra que uno de los factores fuertemente asociado con la postergación de la actividad sexual, es la afiliación o membrecía a religiones judeo-cristianas, con códigos estrictos de conductas. OBJETIVO: analizar la asociación entre religiosidad y comportamientos sexuales en adolescentes. MÉTODO: Estudio transversal analítico en una población adolescente. Se compararon adolescentes católicas, evangélicas y sin religión. Se analizó la asociación entre afiliación y asistencia a servicios religiosos y edad de inicio de la actividad sexual, uso de condón y número de parejas sexuales. RESULTADOS: Se entrevistaron 5.231 adolescentes (mediana de edad 16 años, 91,6% mujeres, 97,3% estudiantes). Las adolescentes que se declaran evangélicas, dejan de asistir a los servicios religiosos en mayor proporción que las adolescentes católicas al iniciar actividad sexual. La afiliación religiosa, sea católica o evangélica, retarda el inicio de la actividad sexual y disminuye el riesgo de tener más de una pareja sexual, comparadas con aquellas sin religión. Pero la afiliación religiosa, sea católica o evangélica, aumenta la posibilidad del no uso de condón, en comparación con aquellas sin religión. CONCLUSIÓN: La afiliación religiosa influye en los comportamientos sexuales en adolescentes, disminuyendo el riesgo en el inicio sexual y en el número de parejas sexuales, aumenta la posibilidad del no uso de condón pero no influye en el uso de anticonceptivos orales.

BACKGROUND: Evidence shows that one of the factors associated with the postponement of sexual activity is membership or affiliation to Judeo-Christian religions, with strict codes of behavior. OBJECTIVE: To analyze the association between religiosity and sexual behaviors in adolescents. METHOD: Analytical cross-sectional study conducted in a population of adolescents. Were compared catholic, evangelical and without religion. Association between affiliation and assistance religious services and age sexual initiation, condom use and number of sexual partners were analyzed. RESULTS: In total, 5.231 adolescents (median age 16 years, 91.6% female, 97.3% students,), were interviewed. Adolescents who declare to be evangelicals cease to attend religious services in greater proportion than Catholic adolescents when initiating sexual activity. Religious affiliation, whether Catholic or evangelical, delay the onset of sexual activity and decreases the risk of having more than one sexual partner, compared with those without religion, but religious affiliation, whether Catholic or evangelical, increases the risk of non-use of condoms, compared to those without religion. CONCLUSION: Religious affiliation influences sexual behaviors in adolescents, decreasing the risk in the age of sexual debut and in the number of sexual partners but increasing the risk in the non-use of the condom but does not influence the pill use.

Application of Narrative Medicine in the Mediation of Medical Disputes / 中国医学伦理学

This paper analyzed a medical dispute mediation case through three main elements of narrative medicine including attention,representation,and affiliation.It discussed the significant impact of narrative medical skills on medical dispute resolution.The three elements reflected in the mediation of medical disputes are to adopt patients' all requests without preset positions,guide both sides to narrative the treatment process,and remedy the impaired doctor-patient relationship.In the process of current medical dispute mediation,the resolution of medical disputes keeps at a superficial level,causes the incomplete restoration of impaired doctor-patient relationship,and therefore influences the neutrality of mediation,just because of the lack of those three elements.

Orientación Religiosa, Identidad Grupal y Religiosidad como Predictores del Fundamentalismo Religioso / Religious Orientation, Group Identity and Religiosity as Predictors of Religious Fundamentalism

Resumen: El fundamentalismo religioso es clave para entender situaciones de discriminación y violencia que se viven alrededor del mundo, conocer qué es lo que se encuentra detrás de esta característica psicosocial de las personas, puede ayudar a entender y prevenir este tipo de comportamientos nocivos. El objetivo de este estudio fue conocer el papel que desempeñan las variables de orientación religiosa, identidad grupal y religiosidad como predictores del fundamentalismo religioso. La muestra estuvo integrada por 533 personas residentes del Distrito Federal y del estado de Guanajuato, pertenecientes a alguna de las cuatro principales ideologías religiosas presentes en México, Católicos (160), Testigos de Jehová (142), Cristianos Evangélicos (115) y no religiosos (116), 50.3% de los cuales fueron mujeres. Los resultados, obtenidos mediante el análisis de regresión, revelan que los tres tipos de orientación religiosa: Orientación Religiosa Intrínseca (ORI), Orientación Religiosa Extrínseca Social (ORES) y Orientación Religiosa Extrínseca Individual (OREI), así como la Identidad Grupal Negativa (IGN) y la Religiosidad son buenos predictores de los componentes del fundamentalismo religioso.

Abstract: Religious fundamentalism is key to understanding existing discrimination and violence worldwide. Knowing what is behind this psychosocial characteristic can help understand and prevent this type of harmful behavior. The aim of this study was to determine how religious orientation (RO), group identity (Gl), and religiosity predict religious fundamentalism. The sample consisted of 533 residents of México City and the state of Guanajuato (50.3% women; Mean age = 36), that belonged to one of four major Mexican religious ideologies: Catholic (n = 160), Jehova's Witnesses (n = 142), Evangelical Christian (n = 115) and non-religious (n = 116). Four psychological scales were used: 1) Fundamentalism Scale, which consists of two subscales: Orthodoxy and Conservatism; 2) the Religious Orientation Scale, which consists of three subscales: Intrinsic Religious Orientation (IRO), Extrinsic Personal (EPRO), and Extrinsic Social (ORES); 3) Group Identity Scale, which consists of twosubscales: Positive Group Identity (PGI) and Negative Group Identity (NGI); and 4) Religiosity Scale. The regression results revealed that IRO, Religiosity, NGI and ORES were positively related to Orthodoxy. ORI, IGN and Religiosity were positively related to Conservatism. EPRO was negatively related to Conservatism. The results indícate that Religious Orientation, Religiosity, and Group Identity are strong significant predictors of religious fundamentalism.

Rich bacterial assemblages from Maritime Antarctica (Potter Cove, South Shetlands) reveal several kinds of endemic and undescribed phylotypes / Una rica colección de bacterias marinas antárticas (Caleta Potter, islas Shetlands del Sur) revela diversos filotipos endémicos y previamente no descritos

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Bacterial richness in maritime Antarctica has been poorly described to date. Phylogenetic affiliation of seawater free-living microbial assemblages was studied from three locations near the Argentinean Jubany Station during two Antarctic summers. Sixty 16S RNA cloned sequences were phylogenetically affiliated to Alphaproteobacteria (30/60 clones), Gammaproteobacteria(19/60 clones), Betaproteobacteria and Cytophaga-Flavobacteriia- Bacteroides (CFB), which were (2/60) and (3/60) respectively. Furthermore, six out of 60 clones could not be classified. Both, Alphaproteobacteria and Gammaproteobacteria, showed several endemic and previously undescribed sequences. Moreover, the absence of Cyanobacteria sequences in our samples is remarkable. In conclusion, we are reporting a rich sequence assemblage composed of widely divergent isolates among themselves and distant from the most closely related sequences currently deposited in data banks.

A dinâmica perversa na adoção: interrogando sobre filiação / Perverse dynamics in adoption: wondering about parents / La dynamique perverse dans l'adoption: questions concernant la filiation / Las dinámicas perversas de la adopción: interrogando acerca de la filiación

No presente trabalho, propomos discutir situações em que o lugar conferido ao adotando no discurso familiar evidencia que a criança é pensada na relação como um objeto de consumo. Que elementos encontrados nesses casos nos permitem pensar sobre desejo de filho e perversão? Haveria uma tentativa de produzir um Outro completo? Diante disso, abordamos questões relacionadas ao perfilhamento, aos elementos que possibilitam a instauração do lugar de filho, dos lugares de pai e de mãe, visando refletir sobre demandas perversas na adoção, considerando as relações entre sujeito e Outro.

This article consists of a discussion of situations related to the fact that the place assigned to an adopted child in a family's discourse regards the child as an object of consumption. What elements found in such cases allow us to approach the child's desire and perversion? Is there an attempt to produce a complete Other? Thus we are dealing with issues related to the acknowledgment of the child and the elements that allow for the establishment of the places of father, mother and child in order to reflect on the perverse demands in adoption and note the relationships between the subject and the Other.

Dans ce travail, nous proposons discuter des situations où le lieu accordé à l'adoptant dans le discours familier met en évidence que l'enfant est pensé dans la relation comme un objet de consommation. Quels sont les éléments que nous trouvons dans ces cas qui nous permettent de penser le désir d'enfant et la perversion? Existerait-il une tentative de produire un Autre complet? Face à cela, nous abordons les questions associées au profil, aux éléments qui permettent l'instauration du lieu de l'enfant, des lieux des parents, pour réfléchir sur les demandes perverses de l'adoption, en prenant en compte les relations entre le sujet et l'Autre.

En este trabajo proponemos discutir situaciones en donde el lugar conferido al adoptando en el discurso familiar demuestra que el niño es conciebido en la relación familiar como um objeto de consumo. ¿Qué elementos encontrados en estos casos nos permiten pensar en deseo por el niño y perversión? ¿Sería un intento de producir un Otro completo? Frente a todo esto, considerando las relaciones entre el sujeto y el Otro, abordamos cuestiones relacionadas con el prohijamiento, los elementos que permiten instaurar el lugar del hijo, del padre y de la madre, con el objetivo de reflexionar sobre las demandas perversas en la adopción.

The changing landscape of religious affiliation in Brazil between 1980 and 2010: age, period, and cohort perspectives / /Um estudo sobre a filiação religiosa no Brasil entre 1980 e 2010: efeitos de idade, período e coorte / /El cambio de panorama de las afiliaciones religiosas en Brasil entre 1980 y 2010: perspectivas de edad, período y cohorte

There has been a remarkable decline in the number of Catholics in Brazil over the last few decades, a fact that is attributed to the growth of Pentecostal churches and to an increase in the number of people with no religious affiliation. We analyzed the age, period, and cohort effects associated with religious affiliation in Brazil from 1980 to 2010, applying the Hierarchical Age-Period-Cohort and Cross-Classified Random Effects Model. We observed that age effects were significant but low for Catholics and Pentecostals, and were substantial for those with no religious affiliation, with a negative relationship. For these first two religious affiliations, period effects were of greater magnitude with clear trends: negative for Catholics and positive for Pentecostals. Cohort effects were significant for all three affiliations, but magnitudes were lower than the other two effects. We also verified that the likelihood of being a Pentecostal decreased with formal education, and the opposite occurred for persons with no religious affiliation. These effects, however, were smaller for younger cohorts, possibly due to the reduced social selectivity of recent students pursuing higher education and the increase in overall levels of education...

Houve uma marcante redução no número relativo de católicos no Brasil nas últimas décadas, fato que é associado, principalmente, ao crescimento das igrejas pentecostais e neopentecostais, bem como ao aumento no número de pessoas sem filiação religiosa. Foram analisados os efeitos de idade, período e coorte associados à filiação religiosa no Brasil entre 1980 e 2010, com o uso do modelo idade-período-coorte hierárquico e modelos de efeitos randômicos com classificação-cruzada. Observaram-se efeitos de idade significativos, mas de pequena magnitude para católicos e pentecostais, e efeitos substanciais para aqueles sem filiação religiosa, sendo essa com uma relação negativa. Para as duas primeiras afiliações, os efeitos de período eram de maior magnitude e com tendências claras: negativa para católicos e positiva para pentecostais. Os efeitos de coorte foram significativos para as três afiliações, mas as magnitudes foram menores do que para dos dois outros efeitos. Também verificou-se que a propensão em ser pentecostal diminui com o nível de educação, sendo que o contrário ocorre para pessoas sem religião. Entretanto, esses efeitos são menos marcantes para coortes mais jovens, possivelmente por causa da natureza menos seletiva da educação superior atualmente no Brasil e do aumento generalizado dos níveis de educação...

Ha ocurrido una notable reducción en el número de católicos en Brasil en las últimas décadas, un hecho que se atribuye al crecimiento de las iglesias pentecostales y un aumento del número de personas sin afiliación religiosa. Analizamos los efectos de edad, período y cohortes asociadas a las afiliaciones religiosas en Brasil desde 1980 hasta 2010, aplicando modelos Jerárquico de Edad-Período-Cohorte y de Efecto Aleatorio de Clasificación Cruzada. Observamos que los efectos de edad fueron significativos pero de baja magnitud para católicos y pentecostales, mientras fueron sustanciales para aquellos sin afiliación religiosa, con una relación negativa. Para las dos primeras afiliaciones religiosas, los efectos de período fueron de mayor magnitud y presentaron tendencias claras: negativas para los católicos y positivas para los pentecostales. Los efectos de cohorte fueron significativos para todas las tres afiliaciones, pero las magnitudes fueron menores que los otros dos efectos. También verificamos que la propensión a ser pentecostal se reduce con la educación formal, y lo opuesto ocurrió con las personas sin afiliación religiosa. Sin embargo, tales efectos fueron menores para cohortes más jóvenes, posiblemente debido a la reducción de la selectividad social de estudiantes recientes en búsqueda de una educación más alta y al aumento general en todos los niveles de educación...

Level of evidence and geographic origin of articles published in Chilean dental journals / Nivel de evidencia y origen geográfico de los artículos publicados en revistas odontológicas chilenas

The aim of this study is to determine the geographic origin and level of evidence (LE) of articles published in Chilean dental journals during 2012. The target population for the bibliometric study was articles published in exclusively-scientific Chilean dental journals. These variables were analyzed: journal, area, language, country, region, design, scenario, and LE. A total of 120 articles were published in four journals: International Journal of Odontostomatology (IJOS=59), Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral (PIRO=28), Journal of Oral Research (JOR=18), and Revista Dental de Chile (RDC=15). From the total, 80.83 percent were published in Spanish and 70 percent had a Chilean affiliation. Most publications corresponded to areas of pathology (21) others (20) and prosthodontics (20). None of the articles was Level 1 Evidence, 6.49 percent was 2b, 14.29 percent was 2c, 63.64 percent was 4, and 15.58 percent was 5. Chilean dental journals mainly publish articles of domestic origin and low LE.

El objetivo de esta investigación es determinar el origen y nivel de evidencia (NE) de los artículos publicados en las revistas odontológicas chilenas durante el año 2012. Estudio bibliométrico, la población objetivo fueron todos los artículos publicados en revistas dentales chilenas de orientación exclusivamente científica. Se analizaron variables: Revista, Área, Idioma, País, Región, Diseño, Escenario y NE. Se hallaron 120 artículos publicados en cuatro revistas: International Journal of Odontostomatology (IJOS = 59), Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral (PIRO = 28), Journal of Oral Research (JOR = 18) y Revista Dental de Chile (RDC = 15). El 80.83 por ciento de los artículos fue publicado en español y el 70 por ciento corresponden a autores chilenos. La mayor cantidad de publicaciones correspondieron a las áreas de Patología (21), Otra (20) y Prostodoncia (20). No se hallaron artículos de NE 1, 6.49 por ciento fue 2b, 14.29 por ciento fue 2c, 63,64 por ciento fue 4 y 15.58 por ciento fue 5. Las revistas odontológicas chilenas publican principalmente artículos de origen nacional y con un bajo NE.

Cerebral Lateralization of Pro- and Anti-Social Tendencies

Mounting evidence suggest that the right-hemisphere (RH) has a relative advantage, over the left-hemisphere (LH), in mediating social intelligence - identifying social stimuli, understanding the intentions of other people, awareness of the dynamics in social relationships, and successful handling of social interactions. Furthermore, a review and synthesis of the literature suggest that pro-social attitudes and behaviors are associated with physiological activity in the RH, whereas unsocial and anti-social tendencies are mediated primarily by the LH. This hemispheric asymmetry is rooted in several neurobiological and functional differences between the two hemispheres. (I) Positive social interactions often require inhibiting one's immediate desires and considering the perspectives and needs of others. Given that self-control is mediated by the RH, pro-social emotions and behaviors are, therefore, inherently associated with the RH as it subserves the brain's self-restraint mechanisms. (II) The RH mediates experiences of vulnerability. It registers the relative clumsiness and motor weakness of the left limbs, and it is involved, more than the LH, in processing threats and mediating fear. Emotional states of vulnerability trigger the need for affiliation and sociality, therefore the RH has a greater role in mediating pro-social attitudes and behaviors. (III) The RH mediates a holistic mode of representing the world. Holistic perception emphasizes similarities rather than differences, takes a long-term perspective, is associated with divergent thinking and seeing other points-of-view, and it mediates a personal mode of relating to people. All these features of holistic perception facilitate a more empathetic attitude toward others and pro-social behaviors.

Inserção em grupos formais e qualidade de vida entre adolescentes / Insertion in formal groups and quality of life among adolescents

Este estudo avalia a relação entre afiliação a grupos formais e sexo e autoestima, satisfação com a vida e propósito de vida, conjuntamente, enquanto componentes da qualidade de vida de adolescentes. Trata-se de um estudo transversal, com uma amostra de 748 estudantes do 1º ano do ensino médio, com idades entre 13 e 22 anos, alunos de escolas públicas estaduais de um município da grande Porto Alegre. Os instrumentos utilizados para coleta de dados foram: Pil Test, Brief Life Satisfaction Scale e Escala de Auto-Estima de Rosenberg. Os resultados apontam que as três dimensões avaliadas, conjuntamente, foram significativamente afetadas pela pertença a grupos (F(3, 698)=2,88, p<0,05), mas não por sexo. A qualidade de vida adolescente é melhor entre os jovens que participam de grupos formais. O estudo aponta para a participação em grupos formais como um indicativo de saúde positiva e um aspecto relevante para a promoção da saúde.

This present study evaluates the relation between affiliation to formal groups and gender and self-esteem, life satisfaction and purpose of life, altogether, as components of the quality of life of adolescents. This is a transversal study, with a sample of 748 teenager students from the first year of high school, ages between 13 and 22 years-old, of state public schools of a city in the metropolitan area of Porto Alegre. The instruments used to collect the data were: Pil Test, Brief Life Satisfaction Scale and Rosenberg's Self-Esteem Scale. The results indicate that the three aspects evaluated, altogether, were significantly affected by the affiliation to groups (F(3, 698)= 2,88, p<0,05), but not by gender. The adolescent quality of life is better among youngsters who take part in formal groups. The study points out to the participation in formal groups as an indicative of positive health and a relevant aspect for health promotion.