Experiências e estratégias de pessoas com doença falciforme no Distrito Federal: a ruptura biográfica / Experiences and strategies of people with sickle cell disease in the Federal District: the biographical rupture

Resumo Trata-se de um estudo sobre a doença falciforme, enfermidade crônica que afeta muitas pessoas no Brasil. O objetivo foi compreender como as pessoas lidam com as adversidades oriundas do diagnóstico e a ruptura biográfica. A descrição das experiências e estratégias empregadas pelas pessoas compuseram um quadro que expressa os habitus dos entrevistados, construídos em relação dialética com a vulnerabilidade determinada pela doença. A abordagem foi qualitativa e empregou entrevistas focadas como propostas por Merton, a técnica bola de neve aplicada em grupos relacionados à doença falciforme em redes sociais. Sete participantes foram selecionados por serem informantes privilegiados, portadores da doença, maiores de 18 anos, moradores no Distrito Federal e usuários não exclusivos do Sistema Único de Saúde. O material das entrevistas foi categorizado a partir dos núcleos focais empregados. Os resultados apontaram as categorias: ruptura biográfica, experiência e estratégias de enfrentamento, atenção à saúde. Concluímos que é necessária uma sensibilização dos profissionais e da população sobre as dificuldades da condição de vida das pessoas com doença falciforme e a consolidação das políticas públicas e das redes de atendimento para acolher essa população.

Abstract This is a study on sickle cell disease, a chronic illness that affects many Brazilians, that aims to understand and analyze how people address the adversities arising from the diagnosis and the biographical rupture. The description of people's experiences and strategies conjures a picture that expresses the respondents' habitus, built in a dialectical relationship with the vulnerability determined by the disease. We adopted a qualitative approach and focused interviews as proposed by Merton, combined with the snowball technique, applied to groups related to sickle cell disease on social networks. Seven participants were selected because they were privileged informants with the disease, were over eighteen, lived in the Federal District, and were non-exclusive users of the Unified Health System. The interview material was categorized from the focal groups employed. The results indicated the following categories: biographical rupture, experience and coping strategies, and healthcare. It is necessary to sensitize professionals and the population about the challenging living conditions of people with sickle cell disease and the consolidation of public policies and care networks to accommodate this population.

Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Entre a psicanálise e a fenomenologia de Merleau-Ponty: traçando caminhos para uma noção de experiência / Between psychoanalysis and Merleau-Ponty's phenomenology: tracing paths towards a notion of experience / Entre la psychanalyse et la phénoménologie de Merleau-Ponty: traçant des chemins vers une notion d'expérience / Entre el psicoanálisis y la fenomenología de Merleau-Ponty: trazando caminos hacia una noción de experiencia

Partindo de uma articulação entre a psicanálise e a fenomenologia de Merleau-Ponty, o objetivo deste artigo é traçar um caminho na psicanálise para uma noção de experiência. A experiência, seja pensada a partir de problemáticas levantadas pela psicanálise contemporânea, mais especificamente no que concerne aos estados limites, seja a partir da fenomenologia, não pertence a um sujeito, mas comporta uma abertura para o mundo. Com base em certas noções e interpretações de diferentes autores na psicanálise, buscam-se caminhos que permitam alcançar um deslocamento de uma posição idealista ou objetivista. Seguindo as indicações de Winnicott, três eixos são destacados como hipóteses centrais para definir a experiência: a corporeidade, o tempo e o sentido. Por fim, propõe-se um questionamento sobre a possibilidade de conceber a experiência como um conceito para a psicanálise contemporânea

By articulating psychoanalysis and Merleau-Ponty's phenomenology, this article traces a possible path towards a notion of experience. Experience, whether based on the problems raised by contemporary psychoanalysis (limit states) or on phenomenology, does not belong to a subject; rather, it includes an opening to the world. Based on certain notions and interpretations by different authors in psychoanalysis, we sought paths that allow a shift from an idealistic or objectivist position. Following Winnicott's propositions, we highlight three axes as central hypotheses to define experience: corporeality, time, and sense. Finally, we question whether experience can be conceived as a concept for contemporary psychoanalysis

En articulant la psychanalyse et la phénoménologie de Merleau-Ponty, cet article trace un chemin en psychanalyse vers une notion d'expérience. L'expérience, qu'elle soit fondée sur les problèmes soulevés par la psychanalyse contemporaine (états limites) ou sur la phénoménologie, n'appartient pas à un sujet, mais comporte une ouverture au monde. Basé sur certaines notions et interprétations de différents auteurs en psychanalyse, on cherche des voies permettant le passage d'une position idéaliste ou objectiviste. Suivant les propositions de Winnicott, trois axes sont mis en évidence comme hypothèses centrales pour définir l'expérience: la corporéité, le temps et le sens. Enfin, on discute de la possibilité de concevoir l'expérience comme un concept pour la psychanalyse contemporaine

Partiendo de una articulación entre el psicoanálisis y la fenomenología de Merleau-Ponty, el objetivo del artículo es trazar un posible camino en el psicoanálisis hacia una noción de experiencia. La experiencia, ya sea basada en los problemas planteados por el psicoanálisis contemporáneo, más específicamente con respecto a los estados límite, o basada en la fenomenología, no pertenece a un sujeto, sino que incluye una apertura al mundo. A partir de ciertas nociones e interpretaciones de diferentes autores en el psicoanálisis, buscamos formas que permitan lograr un cambio desde una posición idealista u objetivista. Siguiendo las indicaciones de Winnicott, se destacan tres ejes como hipótesis centrales para definir la experiencia: corporalidad, tiempo y sentido. Finalmente, se hace una pregunta sobre la posibilidad de concebir la experiencia como un concepto para el psicoanálisis contemporáneo

Experiencias del equipo de salud en la aplicación del contacto piel con piel / Experiences of the Health Team in the Application of Skin-To- Skin Contact

Introducción: La Organización Panamericana de la Salud refiere que a nivel mundial pocos son los países que aplican el contacto piel con piel cuando lo realizan es por un tiempo inadecuado a pesar de los múltiples beneficios para la madre y el recién nacido. Objetivo: Describir la aplicación del contacto piel con piel desde la experiencia del equipo de salud en un centro materno infantil del sector público en Perú. Métodos: Investigación cualitativa con diseño descriptivo, de tipo estudio de caso, en una muestra no probabilística de 10 integrantes del equipo de salud, elegidos por conveniencia y determinado por saturación y redundancia. Los datos se recolectaron a través de la entrevista semiestructurada en línea. La información se procesó de manera manual, mediante el análisis de contenido temático. Resultados: Se obtuvieron tres categorías: a) aplicación del contacto piel con piel en la atención inmediata del recién nacido, b) estrategias implementadas para la aplicación del contacto piel con piel y c) barreras afrontadas por el equipo de salud para aplicar el contacto piel con piel. Conclusiones: Desde la experiencia del personal de salud, es posible aplicar el contacto pial a piel previa capacitación y sensibilización al equipo de salud, y acondicionamiento del ambiente, a fin de implementarlo como política del establecimiento de salud(AU)

Introduction: The Pan American Health Organization reports that few countries worldwide apply skin-to-skin contact and when they use it is during an inadequate amount of time despite the multiple benefits for the mother and the newborn. Objective: To describe the application of skin-to-skin contact from the experience of the health team in a public maternal and child center in Peru. Methods: A qualitative research with a descriptive design, case study, was carried out in a non-probabilistic sample of 10 members of the health team, chosen by convenience and determined by saturation and redundancy. Data were collected through semi-structured online interviews. The information was processed manually, through thematic content analysis. Results: Three categories were obtained: a) application of skin-to-skin contact in the immediate care of the newborn, b) strategies implemented for the application of skin-to-skin contact, and c) barriers faced by the health team to apply skin-to-skin contact. Conclusions: From the experience of health personnel, it is possible to apply skin-to-skin contact after training and sensitization to the health team and conditioning of the environment, in order to implement it as a policy of the health facility(AU)

Place et vécu psychosocial des proches de schizophrènes suivis au service d'addictologie et d'hygiène mentale d'Abidjan (SAHM) / Psychosocial place and experience of relatives of schizophrenics followed at the addiction and mental hygiene service of Abidjan (SAHM)

La survenue de la schizophrénie chez un membre de la famille n'affecte pas que le malade, elle a une répercussion sur l'ensemble de la sphère familiale. À la vue de cette réalité, nous avons mené une étude transversale à visée descriptive ayant portée sur un échantillon sur 132 proches de patients schizophrènes à Abidjan. Les résultats de cette étude ont montré que : - Dans la majorité des cas (87,13%), les aidants familiaux des patients schizophrènes étaient des membres de la famille nucléaire. Ces aidants familiaux qui assuraient l'essentiel de la prise en charge, exerçaient pour plus de la moitié (57,58%) d'entre eux dans le secteur informel, avaient à 72.22% un revenu mensuel inférieur à 100.000 F.CFA (152,7 euro). Tous nos participants à l'enquête ont affirmé ne recevoir aucune aide extérieure ; - En termes de degré d'implication des proches il ressort que les parents géniteurs et la fratrie étaient les plus impliqués à 78,29%dans frais des médicaments, à 73,49% dans le suivi de l'observance thérapeutique et à 61,36% dans l'apport d'assistance dans les besoins quotidiens de leur proche atteint de schizophrénie ; - Parmi les difficultés rencontrées par les proches dans la prise en charge des schizophrènes, celles qui ont les fréquences les plus élevées sont celles de la stigmatisation (77,78%), l'épuisement financier (73,33%), la fragilité de la santé (62,22%), des difficultés liées à la couchette et à l'alimentation (53,33%) et du manque de temps pour soi-même (46,67%) ; - Les principales réactions psychologiques enregistrées à l'annonce du diagnostic de schizophrénie chez nos enquêtés étaient : tristesse (88,89%) ; découragement (86,67%) et stress (77,78%). Il a été cependant noté qu'au décours du suivi des patients, les principales attitudes enregistrées chez nos participants face à cette situation étaient : renforcement de l'affection (52,67%) et le soutien moral (35,11%).

The occurrence of schizophrenia in a family member does not only affect the patient, it has an impact on the entire family sphere. In view of this reality, we conducted a descriptive cross-sectional study involving a sample of 132 relatives of schizophrenic patients in Abidjan. The results of this study showed that: -In the majority of cases (87.13%), family caregivers of schizophrenic patients were members of the nuclear family. These family carers who provided most of the care, worked for more than half (57.58%) of them in the informal sector, had at 72.22% a monthly income of less than 100,000 CFA francs (152,7 euro). All of our survey participants said they receive no outside help; - In terms of degree of involvement of relatives, it appears that parents and siblings were the most involved at 78.29% in drug costs, at 73.49% in monitoring therapeutic compliance and at 61, 36% in providing assistance with the daily needs of their loved one with schizophrenia. - Among the difficulties encountered by relatives in the care of schizophrenics, those with the highest frequencies are those of stigmatization (77.78%), financial exhaustion (73.33%), the fragility of health (62.22%), difficulties related to bed and food (53.33%) and lack of time for oneself (46.67%). - The main psychological reactions recorded at the announcement of the diagnosis of schizophrenia among our respondents were: sadness (88.89%); discouragement (86.67%) and stress (77.78%). It was however noted that during the follow-up of the patients, the main attitudes recorded by our participants in the face of this situation were: reinforcement of affection (52.67%) and moral support (35.11%)

Enlightenment of Prevention Experience of Scientific Misconduct in Extraterritorial Medical Field to China / 中国医学伦理学

Scientific misconduct of researchers causes great waste of academic resources and academic life, which is not only related to the vigorous development of a country’s scientific undertaking, but also directly affects the reputation of the country in the field of scientific research. Based on the analysis of the causes of scientific misconduct of medical researchers in China, this paper comprehensively summarized a series of mature experiences of extraterritorial medical field in preventing scientific misconduct, and put forward corresponding and reasonable countermeasures and suggestions for China’s scientific research governance from three aspects: establishing an effective governance structure based on the normative framework, clarifying the definition standards of scientific research dishonesty in laws and regulations, and formulating good prevention procedures in a healthy academic environment, in order to promote the healthy development of scientific research in China’s medical field and further promote the innovation and progress of medical science and technology.

Current Situation of Human Experience of Traditional Chinese Medicine and the Key Point of Ethical Review / 中国医学伦理学

In order to speed up the review and approval of new drugs of Traditional Chinese Medicine (TCM) in China, it is accelerating the construction of TCM registration review evidence system, which combines the theory of TCM, human experience and clinical trials, and optimizing the technical requirements for the review of and approval of new drugs of TCM based on ancient classic prescriptions, famous old Chinese medicine prescriptions, and medical institution preparations. The United States has strict requirements on the application for the marketing of herbal medicines. According to the characteristics of herbal medicines and combined with human experience, the European Union has classified registration management, reflecting the regulatory concept of inheritance and innovation. TCM has a long history of human use experience in China, its application has a scope of application, basic requirements, and it is necessary to classify and exempt the declaration materials according to the evidence grading evaluation standards. When the ethics committee reviews the research scheme of human experience of TCM, it should pay attention to the review points such as scientific basis for new drugs or prescriptions of TCM, clinical positioning, applicable population, effectiveness and safety information, research design, sample size, conflict of interest management and informed consent. Finally, Human experience is helpful to formulate the research scheme of new drugs of TCM, which can not only improve the success rate of research and development, but also reduces the cost of research and development, accelerate the marketing of new drugs of TCM, and can benefit more patients.

Qualitative Study of Primary Caregiver Load Experience in Colorectal Stoma Patients / 中国医学伦理学

To deeply explore the load experience of primary caregivers of colorectal stoma patients, analyze their psychological load, understand their load experience when caring for patients, so as to provide theoretical basis for promoting patients’ home rehabilitation and continuous nursing. A semi-structured interview was conducted with the primary caregivers of 10 patients with permanent stoma in a tertiary hospital in Xi’an using a phenomenological research method, and the data were summarized and refined by Colaizzi 7-step analysis. A total of four themes were extracted: complex emotional reactions, lack of knowledge about stoma care, a huge care load on the shoulder, and social and financial support needed. The primary caregivers of colorectal stoma patients have a certain degree of care load in the daily care of the patients. Health care professionals should pay attention to the psycho-emotional changes of these individuals and take targeted interventions to reduce the psychological load of the caregivers and improve the quality of life of the patients and their caregivers.

Trajectory, Perceived Causes and Efforts in Diabetes Selfmanagement: A Qualitative Study Among Young People With Type 2 Diabetes Mellitus and Caregivers

@#Introduction: Previous studies have suggested that young individuals with type 2 diabetes mellitus (T2DM) face challenges in achieving optimal diabetes self-management, leading to difficulties in attaining the recommended glycaemic target. The reasons behind these suboptimal practices remain unclear due to the limited number of studies conducted in Malaysia that focused on diabetes self-management among young people. This qualitative study aimed to understand the lived experience of young people with T2DM on self-management in Malaysia. Methods: Young people at the age of 10 to 24 years, who had been diagnosed with T2DM and the caregivers who managing young people with T2DM were interviewed. Data were thematically analysed with the aid of QSR NVivo version 12. Results: Sixteen young informants and eleven caregivers participated in this study. Three major themes conceptualised the lived experience of diabetes self-management: (1) the trajectory to T2DM diagnosis; (2) perceived causes of T2DM; (3) the efforts in diabetes self-management. The route of diagnosis and experiential knowledge about T2DM might determine their efforts in the self-management among the young people. Healthy eating, medication taking and physical activity were perceived as important tasks in diabetes self-management. The involvement of the caregivers in diabetes self-management evolved over time. Conclusion: The study highlighted the experience of young people and caregivers since the beginning of the diagnosis and their strategies in diabetes self-management. More understanding of the lived experiences of patients and caregivers in disease management within the socio-ecological context could help to improve health-care services and intervention for this population.

Beware of the "high functioning trap" - excessive status expectations in patients with bipolar depression / 四川精神卫生

Maintaining long-term stability of patient's condition is crucial in the treatment for bipolar disorder， while accurately assessing the patient's disease status is important and challenging in maintaining treatment. Excessive status expectation is common in patients with bipolar depression， which would warp the patient's perception of his or her own disease status and， thus， ultimately interfere with clinical decisions. Heightened vigilance should be given to such phenomenon. This paper explores the phenomenon and potential mechanisms of excessive status expectation in patients with bipolar disorder， providing ideas for related diagnosis， treatment and research. ［Funded by Jiangsu Provincial Science and Technology PProject （number， BE2015609）］

Experience of students who participated in psychiatric nursing educational program aiming at competency development / Journal of Rural Medicine

Purpose: To clarify experience of students who participated in psychiatric nursing educational program aiming at competency development.Methods: We conducted a semi-structured interview with five students who participated in a psychiatric nursing educational program and analyzed the results qualitatively and descriptively.Results: We generated 19 categories and 39 subcategories. The students reached [acquisition of diversity and multi-phase viewpoint] through team discussion and attempted to understand patients holistically, including [acquisition of patient’s viewpoints]. Moreover, they formed supportive relationships while [repeating trial and error] and gained self-understanding based on [egocentrism awareness].Conclusion: Participation in this program increased students’ preparedness for psychiatric nursing practical training, believed to contribute to competency development. Some students had difficulty relating to patients and hesitated to express negative emotions while establishing supportive relationships. This indicates the need for an educational approach that encourages students to express negative emotions easily.

Theoretical Exploration of Cancer-related Fatigue in Malignant Tumors Guided by Luobing Theory / 中国实验方剂学杂志

Patients with cancer-related fatigue are prone to symptoms and signs such as anorexia， weight loss， and abdominal distension， which seriously reduces the quality of life and becomes an independent risk factor affecting the survival rate of patients with malignant tumors. Therefore， it is urgent to find effective treatment strategies and drugs. In the past， the academic viewpoint of improving syndromes—a new strategy for tumor treatment was proposed based on the guidance of the Luobing theory. Based on this， this article proposes the pathogenesis of cancer-related fatigue is characterized by spleen and kidney deficiency， stasis and toxin internal obstruction， as well as the treatment method of strengthening the spleen and tonifying the kidney， resolving blood stasis and detoxification guided by the core theory of the Qiluo doctrine of Chengzhi Tiaoping. The representative drug Yangzheng Xiaoji capsules has been developed， not only has good therapeutic effect on solid tumors， but also shows good advantages in treating cancer-related fatigue， which can help to restore the homeostasis of tumor bearing survival in patients with malignant tumors and provide new drug choices for the clinical treatment of cancer-related fatigue.

The cost of primary care: An experience analysis in an urban setting

Objectives@#PhilHealth’s present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site. @*Methods@#A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site. @*Results@#The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita. @*Conclusion@#Our study shows that on the first year of coverage in a government run urban outpatient facility, an allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when coopted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).

Experiences of ZHAO Yonghou in Differentiation and Staged Treatment of Schizophrenia Using the Theory of Ti （Character， 体） and Yong （Function， 用） in Mental Illness / 中医杂志

Based on the theory of ti （character， 体） and yong （function， 用） in mental illness， ZHAO Yonghou's clinical experience in staged differentiation and treatment of schizophrenia is summarized. According to the theory， the core disease location of schizophrenia is in the brain， which is closely related to the organs， qi， and blood. It is proposed to interpret the pathogenesis of schizophrenia from the perspective of “zang-fu organs-qi and blood-brain and spirit”， that is， dysfunction of the zang-fu organs， disharmony of qi and blood， and malnourishment of the brain ti lead to dysfunction of the spirit ti and yong. In clinical practice， treatment of schizophrenia can be divided into four stages， for which the method of treating ti and yong simultaneously is suggested. In the prodromal stage， Liuwei Dihuang Decoction combined with Sini San （六味地黄汤合四逆散） with modifications is used to nourish the kidney and boost marrow， soothe the liver and rectify the spleen. For acute exacerbation with binding of phlegm and heat syndrome， Zhaoshi Yikuang Decoction （赵氏抑狂汤） with modifications is used to clear heat and dispel phlegm， awaken the brain and calm the mind. For phlegm-heat damaging yin pattern， Mengshi Guntan Pill combined with Zengye Decoction （礞石滚痰丸合增液汤） with modifications is used to clear heat and dispel phlegm， enrich yin and calm the mind. For the chronic treatment stage， Yudian Decoction （愈癫汤） with modifications is used to disperse phlegm and dissolve stasis， move qi and awaken the mind. For the rehabilitation and regulation stage， Shenan Pill （神安丸） with modifications is used to boost qi and nourish yin， and tranquilize the mind.

CHEN Tongyun's Experience of Treating Postinflammatory Dyspigmentation by Unblocking and Nourishing Qi and Blood / 中医杂志

This paper summarized the clinical experience of CHEN Tongyun in the treatment of postinflammatory dyspigmentation with the method of unblocking and nourishing qi and blood. It is believed that the core pathogenesis of this disease is poor qi movement and skin blood stasis， for which the method of unblocking and nourishing qi and blood should be used. Postinflammatory pigmentation on the face is mainly caused by qi stagnation and blood stasis， and it is suggested to regulate liver and spleen， move qi and invigorate blood usually with modified Tonghua Decoction （通化汤）. Postinflammatory hypopigmentation is mainly due to qi and blood depletion， for which the treatment should be fortifying the spleen and strengthening kidney， replenishing qi and generating blood， and modified Yangfu Decoction （养复汤） is commonly used. Simultaneously， medicinals of ascending and descending functions， moving qi and blood， warming yang and nourishing yin should be combined， and the results from modern pharmacological research should be considered.

PENG Qinghua's Clinical Experience in Treating Dry Eye by the Therapeutic Method of “Maintaining with the Sweet and Restoring the Body Fluids” / 中医杂志

This paper summarized PENG Qinghua's clinical experience in treating dry eye by applying therapeutic method of maintaining with sweet medicinals and restoring the body fluids. It is believed that the spleen earth insufficiency and fluids damage transforming into dryness are the main pathogenesis of the disease， and the basic therapeutic principle is maintaining with the sweet and restoring the body fluids by mainly using sweet medicines. It is advocated to use mild-sweet herbs， such as Baibiandou （Lablab purpureus subsp. purpureus）， Fuling （Smilax glabra Roxb.）， and Yiyiren （Coix lacryma-jobi L.）， to transport spleen earth， so that qi is restored and body fluids are recovered； moderate-sweet herbs， such as Dangshen （Codonopsis pilosula ［Franch.］ Nannf.）， Taizishen （Pseudostellaria heterophylla ［Miq.］ Pax）， Shanyao （Dioscorea oppositifolia L.） and Zhigancao （Glycyrrhiza glabra L.） are suggested to cultivate earth and generate metal， so as to move qi and circulate fluid； sweet-cool herbs， such as Nanshashen （Adenophora triphylla ［Thunb.］ A.DC.）， Beishashen （Glehnia littoralis ［A.Gray］ F.Schmidt ex Miq.）， Yuzhu （Polygonatum odoratum ［Mill.］ Druce）， Tianhuafen （Trichosanthes kirilowii Maxim.） are suggested to nourish yin and increase body fluids， so as to promote fluid production to moisten dryness. In this way， when the source of fluid is restored and the fluid is circulated， the fluid can be produced continuously， which provides new ideas for the treatment of dry eyes with traditional Chinese medicine.

Experience of LIN Yi in Disease-Syndrome-Syptom Differentiation and Treatment of Breast Cancer in Consolidation Phase / 中医杂志

This article summarized the clinical experience of Professor LIN Yi in applying the idea of disease-syndrome-syptom combination to the differentiation and treatment of breast cancer in consolidation phase. It is believed that the fundamental pathogenesis of breast cancer in consolidation phase is deficiency of healthy qi， so the treatment should emphasize on reinforcing healthy qi as the main and eliminating pathogen as the supplement. Commonly， Sijunzi Decoction （四君子汤）， Shenling Baizhu Powder （参苓白术散）， and Liuwei Dihuang Decoction （六味地黄汤） are used as the basic formula to strengthen the spleen and kidney to reinforce healthy qi， and Baihua Sheshe Cao （Scleromitrion diffusum ［Willd.］ R.J.Wang）， Yiyiren （Coix lacryma-jobi L.）， and ezhu （Curcuma aromatica Salisb.） are used to eliminate cancer toxin. It is also believed that the biological characteristics of different molecular subtypes of breast cancer are of great significance to the syndrome differentiation and treatment in traditional Chinese medicine， therefore， the formulas used in clinical practice are often selected taking into considerations of molecular subtypes of breast cancer. For those with positive sex hormone receptor， the most important thing is to replenish the congenital and benefit kidney essence， with modified Baihua Qiqi Decoction （白花芪杞汤）； for those with negative sex hormone receptor， the first step is to strengthen spleen and replenish kidneys， and it is especially important to strengthen the spleen with Baihua Qiling Decoction （白花芪苓汤）. At the same time， it is suggested that the primary and the secondary symptoms of patients should be differentiated， and the diseases and symptoms， as well as the modern medical laboratory indicators should be combined to give suitable medication.

Review and Prospect of Development Status of Traditional Chinese Medicine Processing Technology from 1.0 to 4.0 / 中国实验方剂学杂志

The development and application of processing technology is closely related to the quality of Chinese medicine. Currently， Chinese medicine processing is still in the mechanization stage with limited processing equipment， low levels of automation and intelligence. As a result， the imprecise control of parameters during processing leads to unstable quality of Chinese herbal pieces. However， with the arrival of the big data era and the continuous development of "Internet+"， Chinese medicine processing technology and equipment have been continuously improved and updated， and gradually shifted to the development direction of automation and intelligence. The linkage production technology of Chinese herbal pieces optimizes the separate processing equipment coupling into the production line for continuous manufacture of Chinese herbal pieces， intending to improve production efficiency. The large-scale industrialized production of Chinese herbal pieces tends towards digital technology of processing experience and online inspection technology based on machine vision， electronic nose， and electronic tongue. These technologies are crucial prerequisites for standardizing the parameters of Chinese medicine processing. And further by docking the processing process and equipment with the internet， realizing the intelligent control of the production process is an important process for the transformation and upgrading of Chinese herbal piece industry in the future. In this paper， we summarized the development characteristics of different stages of Chinese medicine processing technology， combed application and development of processing theory， the evolution of processing equipment， and problems in the current industrial development stage of Chinese medicine processing， in order to provide ideas and methods for achieving digital and intelligent innovation of processing technology as well as high-efficient and high-quality production of Chinese herbal pieces.

El trasfondo romántico del concepto de religión de Max Scheler

En la modernidad, la reflexión moral ha estado influida por orientaciones fundamentadas en la razón y en el sentimiento. Dos ejemplares de estas orientaciones son la Ilustración y el Romanticismo, respectivamente. El desarrollo de estos movimientos culturales e intelectuales está asociado a las demandas por los derechos políticos y sociales, junto a la insistencia en la importancia de la solidaridad y la hermandad en el desarrollo de las comunidades. Este artículo de reflexión presenta una perspectiva interpretativa del concepto de religión de Max Scheler La reflexión está enfocada en las raíces románticas de la propuesta Scheleriana, derivadas de la discusión moderna entre el Racionalismo y el Romanticismo. Adicionalmente, se presenta el contexto político y social al que responde la conceptualización de Scheler: Como resultado de esta reflexión, se concluye que el concepto de religión de Scheler reivindica la importancia de los valores y el compromiso moral frente a las crisis políticas que sufrió Europa a inicios del siglo XX.

In modernity moral reflection has been influenced by orientations grounded in reason and in feeling. Two exemplars of these orientations are the Enlightenment and Romanticism, respectively The development of these cultural and intellectual movements is associated with demands for social and political rights, together with the insistence in the importance of solidarity and brotherhood in the development of communities. This reflection paper presents an interpretative perspective of Max Scheler's concept of religion. The reflection is focused on the romantic roots of the Schelerian proposal, derived from the modern discussion between Rationalism and Romanticism. Additionally the political and social context to which Scheler's conceptualization responds is presented. As a result of this reflection, it is concluded that Scheler's concept of religion claims the importance of values and moral commitment against Europe's political crises at the beginning of the 20th century.

Na modernidade, a reflexão moral foi influenciada por orientações baseadas na razão e no sentimento. Dois exemplos dessas orientações são o Iluminismo e o Romantismo, respectivamente. O desenvolvimento desses movimentos culturais e intelectuais está associado a demandas por direitos políticos e sociais, juntamente com a insistência na importância da solidariedade e da fraternidade no desenvolvimento das comunidades. Este artigo de reflexão apresenta uma perspectiva interpretativa sobre o conceito de religião de Max Scheler O foco da reflexão são as raízes românticas da abordagem scheleriana, derivadas da discussão moderna entre racionalismo e romantismo. Além disso, é apresentado o contexto político e social ao qual a conceitualização de Scheler responde. Como resultado dessa reflexão, conclui-se que o conceito de religião de Scheler reivindica a importância dos valores e do compromisso moral diante das crises políticas sofridas pela Europa no início do século XX.

Cambios en el currículum de la educación física chilena: voces desde el territorio / Changes in the chilean physical education curriculum: voices from the territory / Mudanças no currículo da educação física chilena: vozes do território

El objetivo de la investigación fue analizar el desarrollo del currículum en los últimos años y la didáctica que utilizan profesores de Educación Física en una región del centro sur de Chile. La metodología del estudio es de tipo cualitativa, a través de entrevistas a docentes con al menos cinco años de permanencia en el sistema educacional. Los resultados dan cuenta de que los profesores abordan el proceso de enseñanza-aprendizaje analizando el contexto en que están inmersos. Al momento de planificar sus clases se apoyan en las bases curriculares dispuestas por el Ministerio de Educación y las características de los estudiantes. Se concluye que, respecto a los desafíos actuales, buscan llevar a la práctica un modelo constructivista, procurando que el estudiante sea parte del proceso educativo, tomando en cuenta su integridad y bienestar. Asimismo, se espera que el currículum incorpore las problemáticas actuales que emergen en la sociedad.

The objective was to analyze the curriculum development and the didactics used by Physical Education teachers in recent years in a region of south-central Chile. The methodology of the study is qualitative, in which interviews were conducted with teachers with at least 5 years of permanence in the educational system. The results show that teachers approach the teaching-learning process by analyzing the context in which they are immersed. When planning their classes, they rely on the curricular bases established by the Ministry of Education and the characteristics of the students. Regarding current challenges, they seek to implement a constructivist model, making the student part of the educational process, taking into account their integrity and well-being. It is also hoped that the curriculum can incorporate the current problems emerging in society.

O objetivo foi analisar o desenvolvimento do currículo nos últimos anos e a didática utilizada pelos professores de Educação Física em uma região do centro-sul do Chile. A metodologia do estudo é qualitativa, em que foram realizadas entrevistas com professores com no mínimo 5 anos de permanência no sistema educacional. Os resultados mostram que os professores abordam o processo de ensino-aprendizagem analisando o contexto em que estão inseridos. Ao planejar suas aulas, eles se baseiam nas bases curriculares estabelecidas pelo Ministério da Educação e nas características dos alunos. Conclui-se que, face aos desafios atuais, procuram implementar um modelo construtivista, tornando o aluno parte do processo educativo, tendo em conta a sua integridade e bem-estar. Da mesma forma, espera-se que o currículo incorpore os problemas atuais que surgem na sociedade.