Una investigación etnográfica sobre la violencia médica en los centros de salud de Nepal / Ethnographic Investigation into Medical Violence in Nepali Healthcare Facilities / Uma investigação etnográfica da violência médica em centros de saúde no Nepal

Introducción: la violencia no es un subproducto inherente de las relaciones humanas, pero los con-flictos sí lo son. En este artículo se examinan los factores y circunstancias que conducen a la tensión y los conflictos entre las personas que buscan atención médica y los establecimientos médicos nepalíes y los miembros del personal que trabajan allí. Desarrollo: embebido con una revisión de la literatura relevante, a través del análisis de datos etnográficos generada a partir de la investigación de campo y el análisis de contenido de la representación de noticias seleccionada, el artículo se desarrolla en cuatro secciones diferentes. La primera parte trata sobre el contexto de las consultas médicas que resultan en el desarrollo de una relación problemática. A esto le sigue el examen de los diferentes tipos de violencia, enfrentamientos y protestas que surgen a través de tales relaciones. En la tercera parte se analizan las implicaciones de las crecientes promesas médicas y el consiguiente aumento de las expectativas, mien-tras que la última parte destaca cómo las prácticas médicas típicas que existen en los propios hospitales nepaleses aumentan la posibilidad de enfrentamientos y violencia. Conclusión: la frecuente ocurrencia de peleas y violencia médica tanto en hospitales públicos como privados en Nepal sugiere que hay una bre-cha de comunicación entre los proveedores de servicios y el paciente debido a la naturaleza esotérica de la medicina. El conflicto y la violencia hacia los proveedores de servicios también pueden prosperar en el contexto de un modelo explicativo diferencial de las dos partes. La creciente animosidad también indica una disminución de la confianza entre los proveedores de atención médica y los solicitantes en Nepal

Introduction: Violence is not an inherent by-product of human relationships, but conflicts are. This arti-cle examines the factors and circumstances that lead to tension and conflicts between health seekers, and their counterpart Nepali medical establishments, and their staff members. Development: The article is divided into four sections by embedding a relevant literature review, analyzing ethnographic data generated from field research, and analyzing the content analysis of selected news portrayals. The first section discusses the context of the medical consultations that lead to the development of a problematic relationship. This is followed by examining the various types of violence, confrontations, and protests that arise from such relationships. The implications of rising medical promises and resulting height-ened expectations are discussed in the third section. The last section focuses on how common medical practices in Nepali hospitals increase the possibility of confrontations and violence. Conclusions: The prevalence of tussles and medical violence in Nepal's public and private hospitals suggests that they can occur in any hospital, regardless of ownership. Because of the esoteric nature of medicine, there is always a communication gap between service providers and patients. Conflict and violence against service providers can thrive in the context of a two-sided differential explanatory model. The growing hostility also indicates a decline in trust between healthcare providers and patients in Nepal

Introdução: a violência não é um subproduto inerente às relações humanas, mas o conflito é. Este artigo examina os fatores e circunstâncias que levam à tensão e ao conflito entre as pessoas que pro-curam cuidados médicos e os estabelecimentos médicos nepaleses e os funcionários que aí trabalham. Desenvolvimento: incorporada a uma revisão da literatura relevante, através da análise de dados etno-gráficos gerados a partir da pesquisa de campo e da análise de conteúdo da representação noticiosa selecionada, o artigo desenvolve-se em quatro seções distintas. A primeira parte trata do contexto das consultas médicas que resultam no desenvolvimento de uma relação problemática. Em seguida, exa-minamos os diferentes tipos de violência, confrontos e protestos que surgem através de tais relações. A parte três discute as implicações das crescentes promessas médicas e o consequente aumento das expectativas, enquanto a última parte destaca como as práticas médicas típicas que existem nos próprios hospitais nepaleses aumentam o potencial de confrontos e violência. Conclusão: a frequente ocorrência de brigas e violência médica em hospitais públicos e privados no Nepal sugere-nos que podem ocorrer em qualquer hospital, independentemente do proprietário. Sempre existe uma lacuna de comunicação entre os prestadores de serviços e o paciente devido à natureza esotérica da medicina. O conflito e a vio-lência contra os prestadores de serviços também podem florescer no contexto de um modelo explicativo diferencial das duas partes. A crescente animosidade também indica um declínio na confiança entre os prestadores de cuidados de saúde e os requerentes no Nepal

Pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d' Abomey-Calavi au Bénin / NA

L'hypertension artérielle est une maladie à forte progression reste un problème de santé publique. Mais, les pratiques de sa prise en charge se heurtent à différents obstacles. Cette recherche questionne les problèmes qui caractérisent les pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d'Abomey-Calavi au Bénin. Pour y parvenir, nous avons opté pour une analyse basée sur les méthodes quantitatives et qualitatives. L'échantillon est constitué de 130 personnes enquêtées. De l'analyse des résultats collectés, des difficultés éprouvées entre patients et agents de santé dans la prise en charge de l'hypertension artérielle, se caractérise par le manque de relation soignant-soigné. De même, 90% des enquêtés estiment avoir peu de ressources humaines qualifiées et du faible pouvoir d'achat des patients pour faire face aux coûts élevés du traitement de l'hypertension (86,75%). Ainsi, le manque de plateau technique et les frais de consultations spécialisées posent problèmes y compris les suivis de l'éducation hygiéno-diététique. Cet état de fait compromet les pratiques de prise en charge et les formations globales que le système soin est supposé assurer aux usagers qui le fréquentent. Ces résultats suggèrent l'urgence de formations pour le renforcement des capacités pour repérer la précarité et la réorganisation des mesures de prise en charge de l' hypertension artérielle dans le périmètre sanitaire béninois.

Arterial hypertension remains a rapidly growing public health problem. However, management practices face a number of obstacles. This research questions the problems that characterize arterial hypertension management practices at the Centre Hospitalier et Universitaire d'Abomey-Calavi in Benin. To achieve this, we opted for an analysis based on quantitative and qualitative methods. The sample consisted of 130 respondents. From the analysis of the results collected, of the difficulties experienced between patients and health workers in the management of arterial hypertension, most of those surveyed claimed to have a complexity that characterizes the training of health workers. Similarly, 90% of respondents felt that they had few non-cardiologist practitioners, and that patients had little purchasing power to meet the high costs of treating hypertension (86.75%). As a result, the cost of specialized consultations and complementary examinations poses a problem, including follow-up health and diet education. This state of affairs compromises management practices and the comprehensive training that the healthcare system is supposed to provide for its users. These results suggest the urgent need for training to identify precariousness, and the reorganization of hypertension management measures within the Beninese health perimeter.

Characteristic Analysis of Imprinting Template of Flavonoid Clusters in Four Chinese Medicines to Lung Meridian and Establishment of Experimental Approach of Meridian Tropism in Vitro / 中国实验方剂学杂志

ObjectiveTo study the characteristics of imprinting template of flavonoid clusters in four Chinese medicines attributed to the lung meridian， and to establish an in vitro experimental approach for the study of the attribution of Chinese medicines to the lung meridian. MethodBased on 13 Chinese medicines， including Xanthii Fructus， Houttuyniae Herba， Fagopyri Dibotryis Rhizoma， Belamcandae Rhizoma and so on， which only belong to the lung meridian in Chinese Materia Medica（the 13th Five-Year planning textbook of general higher education）， we identified four representative Chinese medicines， namely Houttuyniae Herba， Fagopyri Dibotryis Rhizoma， Belamcandae Rhizoma and Mori Cortex， and set up their fingerprints by high performance liquid chromatography（HPLC） and calculated the molecular connectivity indices of various components in the four Chinese medicines， the similarity to their mean value was calculated by included angle cosine method， so as to establish the quantitative relationship of construction versus imprinting ability， and to determine the order of each component in the lung meridian. A total of 7 reference substances， including chlorogenic acid， rutin， quercetin， isoquercitrin， hyperoside， epicatechin， and iridin， were selected to validate the overall conformational relationships of flavonoids of the model， as well as its predictive ability. ResultHouttuyniae Herba， Fagopyri Dibotryis Rhizoma， Belamcandae Rhizoma and Mori Cortex contained a total of 437 chemical components with an average molecular connectivity index similarity of 0.995 6. The four Chinese medicines contained a total of 204 flavonoids with an average molecular connectivity index similarity of 0.978 0， which was second only to the alkaloids with 0.985 1. The retention time（tR） of the 7 reference substances showed a good conformational relationship with the similarity of the molecular connectivity index（tR=831.4×S-790.3， r=0.861 4， P<0.01）， which was applicable to the in vitro attribution study of the position， similarity， and relative similarity with tR of the cluster of 98.04% of flavonoids. Accordingly， the 1st position was kuwanon D， with a similarity of molecular connectivity index of 0.987 7 and a tR of 30.88 min， the 200th position was chlorogenic acid， with a similarity of molecular connectivity index of 0.958 2 and a tR of 6.36 min. The total first-order moment of the four Chinese medicines calculated by total statistical moment method of fingerprint was 24.26 min， ranked 21， which could characterize 99.19% of the whole， and the total first-order moment of the total peak area of the 7 reference substances in the four Chinese medicines was 20.00 min， with a rank of 46， which could characterize 98.68% of the whole. ConclusionFlavonoid clusters are suitable probes for the characterization of imprinting template for the study of the lung meridian， which can be established a quantitative imprinting method for meridian tropism of Chinese medicines in vitro.

Oclusión basada en evidencia: rompiendo paradigmas / Occlusion based on evidence: breaking paradigms

La odontología basada en evidencias es una metodología que busca que las decisiones clínicas diarias que toman los profesionales en estomatología se encuentren fundamentadas en la evidencia científica, en ella se integran las experiencias clínicas, las necesidades, las preferencias del paciente y la evidencia clínicamente relevante más actual analizada por pares. Estos pilares son parte del proceso en la toma de decisiones para la atención al paciente. La odontología basada en evidencias surge de las exitosas experiencias obtenidas con el desarrollo e implementación de la medicina fundamentada en pruebas, al aplicar el método científico en la evaluación, planificación y toma de decisiones de las prestaciones sanitarias, sobre todo a través de los estudios controlados. En general, toda la práctica odontológica ha tenido grandes avances basados en evidencias, con hechos verídicos comprobados, pero los conceptos fundamentales de oclusión no han tenido una mejora cimentada en el conocimiento científico, prueba de ello es que se siguen ocupando teorías y conceptos de las filosofías de oclusión en la rehabilitación de muchos pacientes, seguimos creyendo en mitos y sofismas que no han podido ser demostrados. En esta revisión, demostramos los grandes avances en los conceptos de oclusión e invitamos a todos los odontólogos a romper los paradigmas de la oclusión antigua sin evidencias científicas y a utilizar las herramientas del método científico en la práctica clínica odontológica (AU)

Evidence-based dentistry is a strategy that seeks to ensure that the daily clinical decisions made by the dental professional are based on scientific evidence. It integrates the clinical experience of the dentist, the needs and preferences of the patient, and the most current relevant clinical evidence. All three are part of the decision-making process for patient care. Evidence-based dentistry arises from the successful experiences obtained with the development and implementation of evidence-based medicine, applying the scientific method in the evaluation, planning and decision-making of health benefits, especially through controlled studies. In general, all dental practice has had great advances based on evidence, with proven true facts, but the fundamental concepts of occlusion have not had an improvement based on scientific knowledge, proof of this is that theories and concepts continue to be used. of the philosophies of occlusion in patient rehabilitation, we follow myths and sophisms that have not been demonstrated, in this review, we demonstrate the great advances in the concepts of occlusion and we know all dentists to break the paradigms of the old occlusion without scientific evidence (AU)

Compter pour "rien": l'objet dans la clinique de l'anorexie / Compter pour "rien": l'objet dans la clinique de l'anorexie / Count as "nothing": the object in the clinic of anorexia / Contar como "nada": el objeto en la clínica de la anorexia

Les caractéristiques usuelles de l'anorexie mentale — inanition, amaigrissement, aménorrhée — justifient que celle-ci soit prise en compte, du point de vue psychopathologique, bien plus en tant que "clinique de l'objet" que comme "dysfonctionnement alimentaire" ou "trouble de la représentation corporelle". En effet, est mis ainsi en lumière non seulement le fait que la nourriture y vient présentifier l'"objet du désir" sous la forme du "rien", mais aussi le fait que si le corps du sujet anorectique se consume, c'est parce qu'il est le siège d'une jouissance spécifique de la position féminine, d'une "jouissance Autre", qu'il contribue paradoxalement de la sorte à contenir et à pacifier.

Resumos As características habituais da anorexia nervosa — fome, emaciação, amenorreia — justificam que seja considerada, de um ponto de vista psicopatológico, muito mais como uma "clínica do objecto" do que como uma "disfunção alimentar" ou "desordem de representação do corpo". De fato, isto realça não só o fato de a comida presentificar o "objeto de desejo" sob a forma de "nada", mas também o fato de que se o corpo do sujeito anorético é consumido, é porque é a sede de um gozo específico da posição feminina, um "Outro gozo", que paradoxalmente contribui para conter e pacificar.

The usual characteristics of anorexia nervosa — starvation, emaciation, amenorrhea — justify that it be considered, from a psychopathological point of view, much more as a "clinic of the object" than as an "eating dysfunction" or a "disorder of body representation." In fact, this highlights not only the fact that food presents the "object of desire" in the form of "nothing," but also the fact that if the body of the anorectic subject is consumed, it is because it is the seat of a specific jouissance of the feminine position, an "Other jouissance," which it paradoxically contributes to containing and pacifying.

Las características habituales de la anorexia nerviosa —hambre, emaciación, amenorrea— llevan a justificarla, desde el punto de vista psicopatológico, mucho más como una "clínica del objeto" que como una "disfunción alimentaria" o "trastorno de la imagen corporal". En efecto, esto pone de relieve no solo el hecho de que la comida presentifica el "objeto de deseo" en forma de "nada", sino también el hecho de que si el cuerpo del sujeto anoréxico se consume, esto se debe a la sed de un goce específico de la posición femenina, un "Otro goce" que paradójicamente contribuye a contenerlo y apaciguarlo.

Relacionamentos ab-usivos / Abusive relationships / Relation abusive / Relación ab-usiva

O presente artigo tem como objetivo compreender os aspectos que envolvem a permanência e a passividade das vítimas de relacionamentos abusivos a partir de conceitos psicanalíticos. Para tanto, utilizou-se conceitos de Freud e Lacan, articulando a relação do sujeito com a linguagem e suas implicações na relação sujeito e Outro, que envolvem aspectos como desejo, amor e gozo. Assim, optou-se por nomear tal dinâmica relacional de relacionamento ab-usivo, entendendo que algo da ordem de uma satisfação inconsciente se atualiza nessas relações, e que neste sentido, toda relação comporta algo de ab-usivo. Considera-se fundamental que, diante de tal demanda, o analista tenha um olhar para a cena inconsciente do sujeito que se apresenta, e que a análise possibilite que algo do "um" se sustente, para que o sujeito sustente uma condição de menos assujeitamento ao seu modo de gozo.

This article aims to understand the aspects that involve the permanence and passivity of victims of abusive relationships based on psychoanalytic concepts. For this purpose, concepts from Freud and Lacan were used, articulating the subject's relationship with language and its implications in the subject's relationship with the Other, which involve aspects such as desire, love, and jouissance. Thus, it was decided to name such relational dynamics an ab-usive relationship, understanding that something of the order of an unconscious satisfaction is actualized in these relationships, and that, in this sense, every relationship involves something ab-usive. It is considered essential that, in the face of such a demand, the analyst has a look at the unconscious scene of the subject who presents himself and that the analysis allows something of the "one" to be sustained so that the subject sustains a condition of less subjection to your way of jouissance.

Cet article vise à comprendre les aspects qui impliquent la permanence et la passivité des victimes de relations abusives à partir de concepts psychanalytiques. À cette fin, nous avons utilisé des concepts de Freud et de Lacan qui articulent la relation du sujet avec le langage et ses implications dans la relation du sujet à l'Autre, qui impliquent des aspects tels que le désir, l'amour et la jouissance. Nous avons donc choisi de nommer cette dynamique relationnelle relation a-busive, considérant qu'une sorte de satisfaction inconsciente se produit dans ces relations, et qu'en ce sens, toute relation contient quelque chose d'a-busif. Il est considéré comme fondamental que, face à une telle demande, l'analyste ait un regard sur la scène inconsciente du sujet qui se présente, et que l'analyse permette de soutenir "l'un", afin que le sujet parvienne à une condition de moindre soumission à son mode de jouissance.

El presente artículo tiene como objetivo comprender los aspectos que implican la permanencia y la pasividad de las víctimas de relaciones abusivas, usando como referencia los conceptos psicoanalíticos. Se utilizaron conceptos de Freud y Lacan, articulando la relación entre el sujeto y el lenguaje y sus implicaciones en la relación entre el sujeto y el Otro, que involucran aspectos tales como el deseo, el amor y el gozo. De esta forma, se decidió denominar a tal dinámica relacional como relación ab-usiva, entendiendo que algo del orden de una satisfacción inconsciente se actualiza en este tipo de relaciones, y que en ese sentido, toda relación implica algo ab-usivo. Se considera fundamental que, ante tal demanda, el analista tenga una mirada en la escena inconsciente del sujeto que se presenta, y que el análisis permita que algo del "uno" se sustente, para que el sujeto sustente una condición de menor sujeción a su modo de gozo.

O lugar de enunciação de dois bebês com sofrimento psíquico e atraso de linguagem / El lugar de enunciación de dos bebés con sufrimiento psicológicoy retrasodel lenguaje / The place of enunciation of two babies with psychologicaldistress and language delay / Le lieu d'énonciation de deux bébés souffrant de détresse psychologique et deretard du langage

Este artigo analisa a singularidade linguística e psíquica de dois bebês, com desfecho de linguagem distintos, aos dois anos. Para análise, utilizaram-se a entrevista inicial e continuada, os Indicadores Clínicos de Referência/Risco ao Desenvolvimento Infantil (IRDI), os Sinais Enunciativos de Aquisição da Linguagem (SEAL), além de filmagens da interação entre mãe e bebê. Os resultados indicaram que em apenas um dos casos houve superação do sofrimento psíquico e atraso na linguagem a partir do segundo ano de vida. Tanto o exercício das funções parentais quanto às condições dos bebês são fatores importantes em sua constituição psíquica e linguística, o que traz reflexões interdisciplinares importantes acerca da singularidade na relação entre esses dois aspectos do desenvolvimento infantil

Este artículo analiza la unicidad lingüística y psíquica de dos bebés con un resultado distinto del lenguaje a los dos años. Para el análisis se utilizó la entrevista inicial y continuada, los Indicadores Clínicos de Referencia/Riesgo para el Desarrollo Infantil (IRDI), los Signos Enunciativos de Adquisición del Lenguaje (SEAL), así como imágenes de la interacción entre madre y bebé. Los resultados indicaron que solo uno de los casos había superado la angustia psicológica y el retraso del lenguaje a partir del segundo año de vida. Tanto el ejercicio de las funciones parentales como las condiciones de los bebés son factores importantes en su constitución psíquica y lingüística, lo que trae importantes reflexiones interdisciplinarias sobre la singularidad de la relación entre estos dos aspectos del desarrollo infantil.

This article seeks to investigate the linguistic and psychic uniqueness of two babies with distinct language outcome at two years. For analysis, the initial and continued interview, the Clinical Indicators of Reference/Risk to Child Development (IRCD), the Enunciative Signs of Language Acquisition (SEAL) were used, as well as footage of the interaction between mother and baby. The results indicated that only one of the cases had overcome psychological distress and language delay from the second year of life. Both the exercise of parental functions and the conditions of babies are important factors in their psychic and linguistic constitution, which brings important interdisciplinary reflections on the uniqueness in the relationship between these two aspects of child development

Cet article cherche à enquêter sur l'unicité linguistique et psychique de deux bébés, en considérant les axes structurels de la constitution du psychisme et la participation de la mère et du bébé dans les protoconversations initiales. Pour l'analyse, l'entretien initial et continu, les indicateurs cliniques de référence/risque pour le développement de l'enfant (IRDE), les signes énonciatifs de l'acquisition du langage (SEAL) ont été utilisés, ainsi que des images de l'interaction entre la mère et le bébé. Les résultats ont indiqué qu'un seuldes cas avait surmonté une détresse psychologique et un retard de langage dès la deuxième année de vie. Tant l'exercice des fonctions parentales que les conditions des bébés sont des facteurs importants dans leur constitution psychique et linguistique, cequi amène d'importantes réflexions interdisciplinaires sur le caractère unique de la relation entre ces deux aspects du développement de l'enfant

A clinical application study of digital manufacturing simple intraoral Gothic arch-tracing device in determining the centric relation of complete dentures / 北京大学学报(医学版)

OBJECTIVE@#To verify the consistency between the digital manufacturing simple intraoral Gothic arch-tracing device and the traditional intraoral Gothic arch-tracing device in determining the centric relation of complete dentures restoration.@*METHODS@#Ten outpatients with edentulous jaws were selec-ted, and the centric relation of the patients was determined by digital manufacturing of simple intraoral Gothic arch-tracing device (T1) and traditional intraoral Gothic arch-tracing device (T2); the difference of clinical operation time between the two methods was recorded; the upper and lower edentulous jaw plaster models were scanned with two kinds of centric relation, the Standard Triangle Language (STL) files imported into Geomagic studio software to apply the best fitting of multiple points of the both upper jaw models, the fitted STL files imported into the 3 shape viewer software, and the maximum position deviations of the vertical, labial (buccal) and lingual directions of the mandibular midline area and molar areas in T1 and T2 groups measured. During the clinical complete dentures try-in, we observed whether there was midline deviation in the mouth of T1 group and T2 group, and whether the occlusion of posterior teeth was stable or not.@*RESULTS@#The mean time spent on determining the centric relation of T1 and T2 groups was (41.90±2.64) min, (57.50±2.37) min respectively. Paired t test was conducted in the two groups, P < 0.01 with significant statistical difference; The mean maximum position deviation between T1 group and T2 group of the midline mandibular region in labial lingual direction was (0.32±0.14) mm, that was (0.40±0.23) mm in vertical direction; the mean maximum position deviation of molar area in buccal lingual direction was (0.35±0.23) mm and that was (0.33±0.20) mm in vertical direction. In the vertical and horizontal directions, the maximum position deviation of mandibles between group T1 and group T2 was controlled within 0.5 mm. In the process of clinical complete dentures try-in, there was no deviation from the center line of dentures. There was not warping, swinging and other poor stability phenomena in T1 and T2 groups.@*CONCLUSION@#The digital manufacturing of simple intraoral Gothic arch-tracing device can be used to determine the centric relation of complete dentures, which can not only save time of clinical operation, but also ensure the accuracy of the centric relation.

Social support and parent-child relationship among adolescents and their influence on emotions / 上海预防医学

ObjectiveTo explore the association between social support， parent-child relationships， and depression， anxiety， and loneliness among adolescents， in order to provide a reference for improving mental health in youth. MethodsA total of 11，596 middle school students from two districts of Shanghai were investigated with the stratified random cluster sampling method. The Chinese version of Patient Health Questionnaire （PHQ-2-C）， Generalized Anxiety Disorder （GAD-7）， UCLA Loneliness Scale （ULS-6）， Perceived Social Support Scale and Parent-child Cohesion Questionnaire were used in the survey. Statistical inferences were made using t-test， ANOVA， and logistic regression analysis. ResultsGirls， non-graduates， students ranking in the top 25%， adolescents living with parents and with higher socioeconomic status had higher scores of social support and parent-child cohesion than boys， graduates， students ranking in the middle or in the bottom 25%， adolescents not living with parents and with lower socioeconomic status （P<0.05）. Adolescents' parent-child cohesion and social support were negatively correlated with all kinds of emotions. Parent-child cohesion was an associated factor of depression （OR=0.93， 95%CI：0.91‒0.94）， loneliness （OR=0.94， 95%CI：0.94‒0.95） and anxiety （ORmild=0.98， 95%CI： 0.98‒0.99； ORmoderate or severe=0.96， 95%CI： 0.95‒0.98）， but there were differences in the correlation between emotions and social support in different dimensions. ConclusionSocial support and parent-child relationship are significantly associated with depression， anxiety and loneliness in adolescent students. Paying more attention to youth with different characteristics， taking targeted measures to improve the level of social support and establishing a good family relationship are conducive to promoting the mental health of adolescents.

Optimization of extraction process for classic prescription Yihuang Decoction based on Box-Behnken design-response surface methodology, standard relation, and analytic hierarchy process combined with entropy weight method / 中国中药杂志

Based on the concept of quality by design(QbD), the Box-Behnken design-response surface methodology combined with standard relation(SR) and analytic hierarchy process(AHP)-entropy weight method(EWM) was applied to optimize the extraction process of the classic prescription Yihuang Decoction. The content of geniposidic acid, phellodendrine hydrochloride, and berberine hydrochloride in Yihuang Decoction, the extract yield, and fingerprint similarity were used as the critical quality attributes(CQAs) of the extraction process. The extraction time, water addition, and extraction times were used as the critical process parameters(CPPs). After determining the levels of each factor and level through single-factor experiments, response surface experiments were designed according to the Box-Behnken principle, and the experimental results were analyzed. The SR between each sample and the reference sample under various evaluation indicators of different extraction parameters was calculated. The weights of the five evaluation indicators were determined using AHP-EWM, followed by comprehensive evaluation. A function model between CPPs and CQAs characterized by comprehensive scores was established to predict the optimal extraction process parameters. In the final comprehensive weight coefficients, the yield rate accounted for 43.1%, and the content of berberine hydrochloride, phellodendrine hydrochloride, and geniposidic acid accounted for 35.1%, 6.3%, and 15.5%, respectively. After comprehensive score analysis with SR, the established second-order polynomial model was statistically significant(P<0.01, and the lack of fit was not significant). The predicted optimal extraction conditions for Yihuang Decoction were determined as follows: 8-fold volume of water, extraction time of 1.5 h, and extraction once. The mean comprehensive score of the validation experiment was 85.77, with an RSD of 0.99%, and it met the quality control stan-dards for the reference sample of Yihuang Decoction. The results indicate that the optimized extraction process for Yihuang Decoction is stable and reliable, and the water extract is close in quality attributes to the reference sample. This can serve as a foundation for the research and development of granules in the future. Box-Behnken design-response surface methodology combined with SR and AHP-EWM can provide references for the modern extraction process research of other classic prescriptions.

Theoretical-methodological rationales in caring for family members of people with alcohol use disorders / Racionalidades teórico-metodológicas no cuidado aos familiares de pessoas com transtornos por uso de álcool

Objective: The present study aims to understand the theoretical-methodological rationales which guide psychological care practices for family members of people with alcohol use disorders. Method: For this theoretical-reflective study we conducted a systematic search for literature review articles to learn about the modality of interventions, their theoretical-methodological frameworks and clinical or efficacy results. Afterwards, a complementary search for articles and book chapters was conducted to map and analyze the most used professional care practices and their theoretical assumptions. Results: We identified six theoretical-methodological rationales that guide the professional's clinical reasoning in caring for family members, which are organized around key concepts about their emotional suffering: 1) family stress; 2) family dynamics; 3) behavioral repertoire deficit; 4) codependency; 5) inflexibility; 6) potential for psychological change. Conclusion: The identification of these rationales can aid professionals when planning their practices in a critical and informed manner.

Objetivo: Este estudo objetiva compreender as racionalidades teórico-metodológicas que guiam práticas psicológicas de cuidado a familiares de pessoas com transtornos por uso de álcool. Método: Para este estudo teórico-reflexivo realizamos uma busca sistemática de artigos de revisão de literatura para compreender as modalidades de intervenção, seus enquadres teórico-metodológicos e resultados clínicos ou eficácia. Na sequência, uma busca complementar de artigos e capítulos de livro foi conduzida a fim de mapear e analisar as práticas de cuidado profissional mais utilizadas, bem como seus pressupostos teóricos. Resultados: Foram identificadas seis racionalidades teórico-metodológicas que guiam o raciocínio clínico do profissional em torno de conceitos-chave sobre o sofrimento emocional dos familiares: 1) estresse familiar; 2) dinâmica familiar; 3) déficit de repertório comportamental; 4) conduta codependente; 5) rigidez das defesas psíquicas; 6) potencialidade para a mudança psicológica. Conclusão: A identificação dessas racionalidades auxilia o profissional no planejamento de suas práticas de modo crítico e informado.

Discrepancia anteroposterior en registro de relación céntrica con apoyo central intraoral en cubetas rodetes acrílicas (BOPAYACU) e inducción manual en adultos mayores desdentados totales / Anteroposterior discrepancy in centric relation record with intraoral central support in acylic impaction cups (BOPAYACU) and manual induction in edentulous older adults

Objetivo: Comparar la discrepancia anteroposterior medida a nivel de la platina incisiva de 2 métodos de registro intermaxilar en la misma sesión que la im-presión definitiva en adultos mayores desdentados totales. Materiales y métodos. Se incluyeron en el es-tudio 20 pacientes (n=20) con edad promedio de 70 años. En cada uno de ellos se obtuvieron registros intermaxilares con cubetas rodete de acrílico: uno con inducción manual (IM) y otro autoinducido con el sistema de cubeta rodete de acrílico y apoyo central único utilizando una superficie palatina de registro curva (BYC). Los modelos fueron montados en un ar-ticulador Whip Mix modelo 2240 al que se le adicio-nó un dispositivo de papel milimetrado, Orthodent, a nivel de la platina incisiva, para registrar las dife-rencias existentes entre las posiciones obtenidas. El análisis estadístico se llevó a cabo mediante el cálcu-lo de intervalos de confianza (95%) para las diferen-cias medias y prueba de t de student para datos apa-reados (nivel de significancia: α<0,05). Resultados. En el plano mesiodistal a nivel de la platina incisiva se encontró diferencia estadísticamente significativa entre las dos variables de registro (p<0,001). A este nivel el BYC proporcionó registros más retrusivos que IM. Media aritmética (desviaciones estándar) en milímetros: 3,82 (2,1). Conclusión. El sistema de re-gistro con cubetas rodete acrílicas y BYC incorpora-do a las mismas proporciona un registro intermaxi-lar más retrusivo que IM en adultos mayores des-dentados totales cuando se realizan dichos registros en la misma sesión que la impresión definitiva (AU)

Objective: To compare the anteroposterior discre-pancy measured at the level of the incisal plate of 2 methods of intermaxillary registration in the same session as the definitive impression in fully edentu-lous older adults. Materials and methods. Twenty pa-tients (n=20) with an average age of 70 years were included in the study. On each of them, intermaxillary recordings were obtained with acrylic rims trays: one with manual induction (MI) and the other with a self-induced system and single central support using a curved recording palatal surface (BYC). The models were mounted in a Whip Mix model 2240 articula-tor to which an Orthodent graph paper device was added, at the level of the incisal plate, to record the di-fferences between the positions obtained. Statistical analysis was carried out by calculating confidence intervals (95%) for mean differences and T-student for paired data (significance level: α<0.05). Results. On the mesiodistal plane at the level of the incisal plate, a statistically significant difference was found between the two recording variables (p<0.001). At this level the BYC provided more retrusive recordings than MI. Arithmetic mean (standard deviations) in mi-llimeters: 3.82 (2.1). Conclusions. The registration system with acrylic rim trays and BYC incorporated into them provides a more retrusive intermaxillary registration than MI in fully edentulous older adults when such registrations are made in the same ses-sion as the final impression.(AU)

Operação Suposição de Sujeito no contexto de Terapia Semi-Intensiva Neonatal: relato de caso / Subject Assumption Operating in Neonatal Semi-Intensive Care: Case report / Opération d'assomption du sujet en soins semi-intensifs néonatals : rapport de cas / Operación de suposición del sujeto en el contexto de cuidados semiintensivos neonatales: reporte de caso

A operação de suposição de sujeito compreende um dos quatro eixos que fundamentam a pesquisa IRDI e consiste em uma antecipação realizada pelo agente da função materna de um sujeito no bebê, que não se encontra ainda constituído. Este trabalho se propõe a apresentar um relato de caso que teve como objetivo investigar como a operação de suposição de sujeito ocorre em um contexto de internação em uma Unidade de Terapia Semi-Intensiva Neonatal. Para isso, foram realizadas uma entrevista semiestruturada, a aplicação do protocolo IRDI (Indicadores Clínicos de Risco para o Desenvolvimento Infantil) e do instrumento Denver II. Observou-se que a suposição de sujeito pode ocorrer, mas neste caso clínico apresenta dificuldades para se sustentar e operar, já que a relação mãe-bebê possivelmente foi influenciada pela limitação física do bebê, sua internação prolongada e aspectos emocionais da mãe.

Subject assumption operation is one of the four axes that underlie research using Clinical Indicators of Risk for Child Development (IRDI) and consists of an anticipation performed by the maternal agent on the behalf of a not yet constituted subject - the baby. This paper presents a case report that aimed to investigate how the subject assumption operation occurs in a neonatal semi intensive care unit. To do so, a semi-structured interview was conducted followed by application of the IRDI protocol and the Denver II instrument. Results showed that the subject assumption can occur, but, in this clinical case, it was unsustainable and non-operational, since the mother-child relation was possibly influenced by the physical limitation of the baby, their prolonged hospitalization, and emotional aspects of the mother.

L'opération d'"assomption sujet" comprend l'un des quatre axes qui sous-tendent la recherche utilisant les indicateurs cliniques de risque pour le développement de l'enfant (IRDI) et consiste en une anticipation effectuée par l'agent maternel pour le compte d'un sujet qui n'est pas encore constitué. Cet article présente un rapport de cas qui visait à étudier comment cette opération se déroule dans une unité de soins semi-intensifs néonatals. Pour ce faire, un entretien semi-directif a été mené, suivi de l'application du protocole IRDI et de l'instrument Denver II. Les résultats ont montré que l'hypothèse du sujet peut se produire, mais, dans ce cas clinique, elle était insoutenable et non opérationnelle, puisque la relation mère-enfant était probablement influencée par la limitation physique du bébé, son hospitalisation prolongée et les aspects émotionnels de la mère.

La operación de la suposición del sujeto es uno de los cuatro ejes que sostienen el estudio con indicadores clínicos de riesgo para el desarrollo infantil (IRDI) y consiste en una anticipación realizada por el agente de la función materna de un sujeto en el bebé, que todavía no se encuentra constituido. Este trabajo propone presentar el reporte de caso con el objetivo de investigar cómo la operación de suposición de sujeto ocurre en el contexto de hospitalización en una Unidad de Cuidados Semiintensivos Neonatal. Para eso, se realizaron una entrevista semiestruturada, la aplicación del protocolo IRDI y el instrumento Denver II. Se ha notado que la suposición de sujeto puede ocurrir, pero todavía en este caso clínico se muestran dificultades para que se sustente y opere, una vez que la relación madre-bebé posiblemente fue influenciada por limitaciones físicas del bebé, su hospitalización prolongada y aspectos emocionales de la madre.

Comunicação de más notícias: autopercepção de estudantes de medicina / Breaking bad news: self-perception of medical students / Comunicación de malas noticias: autopercepción de estudiantes de medicina

Resumo Este estudo analisou a autopercepção de estudantes de uma faculdade de medicina em relação a sua aptidão para comunicar más notícias e identificar fatores associados. Mediante questionário autoaplicável, 44,1% do total de 214 participantes se consideraram aptos para a abordagem. Foram associados à maior autopercepção de aptidão para a comunicação de más notícias: mais tempo de curso ( p <0,001); achar que a graduação ofereceu os recursos necessários à aquisição da habilidade de comunicar más notícias ( p <0,001); conhecer algum protocolo validado ( p =0,015); e ter tido necessidade de comunicar má notícia na graduação ( p <0,001). Concluiu-se que a maioria dos estudantes não se sentia apta a comunicar más notícias. Conhecer um protocolo e ter tido necessidade de comunicar más notícias na graduação foram importantes para a aptidão. Sugere-se que o tema seja abordado de forma diferente, com mais atividades práticas.

Abstract This study analyzed medical students' self-perception regarding their aptitude to communicate bad news and identify associated factors. Using a self-administered questionnaire, 44.1% of 214 participants considered themselves suitable for the approach. The following were associated with greater self-perception of aptitude for breaking bad news: more time in the course ( p <0.001); believing that the undergraduate course offered the necessary resources to acquire the skill to communicate bad news ( p <0.001); knowing a validated protocol ( p =0.015); having needed to communicate bad news during the undergraduate course ( p <0.001). In conclusion, most students felt unable to communicate bad news. Knowing a protocol and having the need to communicate bad news during the undergraduate course were essential for aptitude. As a suggestion, the topic should be approached differently, with more practical activities.

Resumen Este estudio analizó la autopercepción de los estudiantes de una facultad de medicina en relación con su aptitud para comunicar malas noticias e identificar factores asociados. A través de un cuestionario autoaplicable, el 44,1 % del total de 214 participantes se consideraron aptos para el enfoque. Se asociaron con una mayor autopercepción de aptitud para la comunicación de malas noticias: más tiempo de curso ( p <0,001); pensar que el pregrado ofreció los recursos necesarios para adquirir la habilidad de comunicar malas noticias ( p <0,001); conocer algún protocolo validado ( p =0,015); y haber tenido necesidad de comunicar malas noticias en el pregrado ( p <0,001). Se concluyó que la mayoría de los estudiantes no se sentían aptos para comunicar malas noticias. Conocer un protocolo y haber tenido la necesidad de comunicar malas noticias en el pregrado fue importante para la aptitud. Se sugiere que el tema sea abordado de forma diferente, con más actividades prácticas.

De objeto da pulsão a objeto-fonte da pulsão: um imperativo epistemológico / From drive object to source of drives object: An epistemological imperative / D'objet de la pulsion à objet-source de la pulsion: un impératif épistémologique / Del objeto de la pulsión al objeto fuente de la pulsión: un imperativo epistemológico

A sexualidade humana, no que se refere à identidade sexual e à escolha de objeto, situa-se no campo do psíquico, ou seja, da pulsão, expressando-se pela fantasia. Sua instalação é precoce, ocorrida ao tempo da sedução da criança pelo adulto, num tempo complexo que conjuga fundação do inconsciente, nascimento da pulsão e instalação do objeto a partir de fora, na chamada situação antropológica fundamental. Como já demonstrado pelo fracasso nas tentativas científicas de encontro de determinantes genéticas para a identidade sexual, o discurso a incidir sobre a sexualidade humana sai definitivamente do campo do natural rumo ao campo do psíquico. Tal constatação implicou, a partir da psicanálise, um remanejamento na própria esfera da epistemologia, de modo análogo à revolução que a antropologia já havia operado ao definir objeto da cultura também fora do campo da natureza.

Human sexuality, with regards to sexual identity and object choice, is located in the psychic field, that is, the drive, expressing itself through fantasy. It starts early, when as a child, one is enchanted by an adult, a complex time that combines the foundation of the unconscious, the drive start and the installation of the object from the outside, in the so-called fundamental anthropological situation. As shown by the failure in scientific attempts to find genetic determinants for sexual identity, the discourse on human sexuality clearly leaves the realm of nature for the psychic. Such observation implied, in the field of psychoanalysis, a shift in epistemology similar to the revolution that anthropology had already operated by defining culture as object outside of nature.

La sexualité humaine, en ce qui concerne l'identité sexuelle et le choix d'objet, se situe dans le champ du psychique, c'est-à-dire de la pulsion, s'exprimant par le fantasme. Son installation est précoce, lorsque, enfant, on est enchanté par un adulte - une époque complexe qui conjugue la fondation de l'inconscient, la naissance de la pulsion et l'installation de l'objet à partir du dehors, dans ce que l'on appelle une situation anthropologique fondamentale. Comme l'a déjà démontré l'échec des tentatives scientifiques pour trouver des déterminants génétiques de l'identité sexuelle, le discours sur la sexualité humaine quitte définitivement le domaine de la nature pour celui du psychique. Cette conclusion impliquait, à partir de la psychanalyse, un remaniement dans la sphère même de l'épistémologie, de manière analogue à la révolution que l'anthropologie avait déjà opérée en définissant l'objet de la culture hors du champ de la nature.

La sexualidad humana, en lo que se refiere a la identidad sexual y a la elección del objeto, se sitúa en el campo psíquico, es decir, el de la pulsión, expresándose a través de la fantasía. Su instalación es precoz al ocurrir en el momento de la seducción del niño por el adulto, en un momento complejo que conjuga la fundación del inconsciente, el nacimiento de la pulsión y la instalación del objeto desde el exterior, en la llamada situación antropológica fundamental. Como ya lo ha demostrado el fracaso en los intentos científicos de encontrar determinantes genéticos para la identidad sexual, el discurso que incide sobre la sexualidad humana sale definitivamente del campo natural al campo de lo psíquico. Tal constatación implicó, a partir del psicoanálisis, una reformulación en la propia esfera de la epistemología, análoga a la revolución que la antropología ya había operado al definir el objeto de la cultura también fuera del campo de la naturaleza.

Impacto da microcefalia no vínculo mãe-bebê e suas repercussões para o desenvolvimento infantil / Impact of microcephaly on the mother-child relations and its repercussions on child development / L'impact de la microcéphalie sur les relations mère-enfant et ses répercussions sur le développement de l'enfant / Impacto de la microcefalia en el vínculo madre-bebé y sus repercusiones para el desarrollo infantil

Resumo O vínculo afetivo entre mãe e bebê é fundamental para o desenvolvimento infantil, mas pode sofrer o impacto de uma condição como a microcefalia, decorrente do contágio pelo vírus zika durante a gravidez. O objetivo deste estudo foi analisar as repercussões da infecção na formação do laço mãe-bebê e seus desfechos para o desenvolvimento infantil. Trata-se de uma pesquisa descritiva, conduzida com nove mães infectadas pelo vírus zika e seus bebês, dentre os quatro nasceram com microcefalia. Todas as mães foram atendidas no hospital Maternidade Escola da Universidade Federal do Rio de Janeiro e responderam ao questionário de Indicadores de Risco para o Desenvolvimento Infantil, e seus bebês foram avaliados pelo Battelle Developmental Inventory 2nd edition. Observou-se que a relação mãe-bebê apresentou mais indicadores de risco para o desenvolvimento infantil quando o bebê tinha microcefalia.

Abstract Affective mother-child relations are fundamental for child development, which can be impacted by conditions such as microcephaly, due to Zika virus infection during pregnancy. This study sought to analyze the ensuing repercussions on the mother-child relations and its outcomes for child development. A descriptive study was conducted with nine mothers infected by Zika virus and their newborns, four of them born with microcephaly. All mothers were attended at the Maternity School Hospital of the Federal University of Rio de Janeiro, and answered the Risk Indicators for Child Development. The newborns were evaluated by the Battelle Developmental Inventory 2nd edition. Results show that the mother-child relations presented higher risk for child development when the newborn had microcephaly.

Résumé Les relations affectives mère-enfant sont fondamentale pour le développement de l'enfant et peut être affecté par des conditions telles que la microcéphalie, due à l'infection par le virus Zika pendant la grossesse. Cette étude a chercher à analyser les répercussions qui en découle sur les relations mère-enfant et leurs conséquences sur le développement de l'enfant. Une recherche descriptive a été menée auprès de neuf mères infectées par le virus Zika et de leurs nouveau-nés, dont quatre atteint de microcéphalie. Toutes les mères ont été suivie à la maternité de l'Université fédérale de Rio de Janeiro, et ont répondu aux Indicateurs de risque pour le développement de l'enfant. Les nouveau-nés ont été évalués par le Battelle Developmental Inventory 2nd edition. Les résultats montrent que la relation mère-enfant présentent un risque plus élevé pour le développement de l'enfant lorsque le nouveau-né est atteint de microcéphalie.

Resumen El vínculo afectivo madre-bebé es fundamental para el desarrollo infantil, sin embargo, puede ser impactado por una condición como la microcefalia, que resulta de la infección por el virus Zika durante el embarazo. El objetivo de este estudio fue analizar las repercusiones de este impacto en el vínculo madre-bebé y sus resultados para el desarrollo infantil. Este es un estudio descriptivo realizado con nueve madres infectadas por el virus Zika y sus bebés, cuatro de ellos nacieron con microcefalia. Todas las madres fueron atendidas en el Hospital Maternidade Escola de la Universidade Federal do Rio de Janeiro y han respondido el cuestionario de Indicadores de Riesgo para el Desarrollo Infantil, y sus bebés fueron evaluados por el Inventario de Depresión de Beck. Se observó que la relación madre-bebé presenta más indicadores de riesgo para el desarrollo del niño cuando el bebé tenía microcefalia.

Saber, inteligência e tradição: o educar e o educador em Chaui, Rancière e Lajonquière / Saber, inteligencia y tradición: el educar y el educador en Chaui, Rancière y Lajonquière / To know, intelligence, and tradition: educating and the educator in Chaui, Rancière and Lajonquière / Connaître, intelligence et tradition: éduquer et éducateur à Chaui, Rancière et Lajonquière

O artigo parte da compreensão que Marilena Chaui, Jacques Rancière e Leandro de Lajonquière expressam sobre aspectos decisivos à relação professor-aluno. Particularmente no que dizem a respeito do ensino-aprendizagem. Com isso, explicitamos uma formulação subjacente ao que pensam esses autores acerca do ser professor. Referendamos suas posições ao identificarmos nelas uma relação entre saber, inteligência e tradição, a qual seja, os lugares que ocupam professor e aluno ante o conhecimento localizado em certa tradição discursiva na qual as personagens dessa trama estão inseridas. Um movimento de ideias tal que, no cotejo entre esses pensadores, culminou num exame sobre omito tecnicizante e desenvolvimentista que tem norteado certas abordagens pedagógicas predominantes no Brasil, especialmente no que concernem ao ser professor

El artículo parte del entendimiento que expresan Marilena Chaui, Jacques Rancière y Leandro de Lajonquière sobre aspectos decisivos de la relación docente-alumno. Particularmente en lo que respecta a la enseñanza y el aprendizaje. Con esto, explicamos una formulación subyacente de lo que estos autores piensan sobre ser docente. Refrendamos sus posiciones al identificar en ellas una relación entre saber, inteligencia y tradición, es decir, los lugares que ocupan docente y alumno frente a saberes ubicados en una determinada tradición discursiva en la que se insertan los personajes de esta trama. Un movimiento de ideas que, en la comparación entre estos pensadores, culminó en un examen del mito tecnizante y desarrollista que ha guiado ciertos enfoques pedagógicos predominantes en Brasil, especialmente en lo que se refiere al ser docente

The article starts from the understanding that Marilena Chaui, Jacques Rancière and Leandro de Lajonquière express about decisive aspects of the teacher-student relationship. Particularly with regard to teaching and learning. With this, we explain an underlying formulation of what these authors think about being a teacher. We endorse their positions by identifying in them a relationship between knowledge, intelligence and tradition, that is, the places that teacher and student occupy in the face of knowledge located in a certain discursive tradition in which the characters of this plot are inserted. A movement of ideas that, in the comparison between these thinkers, culminated in an examination of the technicizing and developmental myth that has guided certain pedagogical approaches prevalent in Brazil, especially with regard to being a teacher

L'article part de la compréhension que Marilena Chaui, Jacques Rancière et Leandro de Lajonquière expriment sur les aspects décisifs de la relation enseignant-élève. Notamment em ce qui concerne l'enseignement et l'apprentissage. Avec cela, nous expliquons une formulation sous-jacente de ce que ces auteurs pensent d'être um enseignant. Nous endossons leurs positions em identifiant em elles une relation entre savoir, intelligence et tradition, c'est-à-dire les places qu'occupent enseignant et élève face à um savoir situé dans une certaine tradition discursive dans laquelle s'insèrent les personnages de cette intrigue. Um mouvement d'idées qui, dans la comparaison entre ces penseurs, a abouti à um examen du mythe technicisant et développemental qui a guidé certaines approches pédagogiques répandues au Brésil, notamment em ce qui concerne le métier d'enseignant

Death and dying of newborns and children: relationships between nursing and family according to Travelbee / Muerte y morir de neonatos y niños: relaciones entre enfermería y familia según Travelbee / Morte e morrer de neonatos e crianças: relações entre enfermagem e família segundo Travelbee

ABSTRACT Objective: Identify the nursing staff's perception of their relationship with families of newborns and children who are in the process of death and dying. Methods: Qualitative research, carried out in the Neonatal and Pediatric Intensive Care Unit of a public maternity hospital in Rio Grande do Norte, with 17 nursing professionals, through a semi-structured interview. After being transcribed, the data were subjected to Bardin's content analysis and interpreted in the light of the theory of Interpersonal Relations proposed by Travelbee. Results: Four categories emerged from the analysis: "Caring and welcoming people, feelings and stories"; "Reactions in the midst of pain: moving between acceptance and suffering"; "Communication of bad news: challenges and strategies"; "The weight of caring and suffering". Final considerations: Family assistance can be established using Travelbee's principles, as they offer timely theoretical support for nursing actions in the context of the process of death and dying.

RESUMEN Objetivo: Identificar la percepción del grupo de enfermería sobre su relación con familiares de neonatos y niños que se encuentran en el proceso de muerte y morir. Métodos: Investigación cualitativa, realizada en Unidades de Cuidado Intensivo Neonatal y Pediatría de una maternidad pública del Rio Grande do Norte, con 17 profesionales de enfermería, mediante entrevista semiestructurada. Tras transcritos, los datos fueron sometidos al análisis de contenido de Bardin e interpretados basados en la teoría de las Relaciones Interpersonales propuesta por Travelbee. Resultados: Del análisis, emergieron cuatro categorías: "Cuidar y acoger personas, sentimientos e historias"; "Reacciones en medio al dolor: transitar entre aceptación y sufrimiento"; "Comunicación de más noticias: desafíos y estrategias"; "El peso del cuidar y del sufrir". Consideraciones finales: La asistencia a los familiares puede ser establecida usándose los principios de Travelbee, pues ofrecen aporte teórico oportuno para acciones de enfermería en contexto del proceso de muerte y morir.

RESUMO Objetivo: Identificar a percepção da equipe de enfermagem sobre sua relação com familiares de neonatos e crianças que se encontram no processo de morte e morrer. Métodos: Pesquisa qualitativa, realizada em Unidade de Terapia Intensiva Neonatal e Pediatria de uma maternidade pública do Rio Grande do Norte, com 17 profissionais de enfermagem, mediante entrevista semiestruturada. Após transcritos, os dados foram submetidos à análise de conteúdo de Bardin e interpretados à luz da teoria das Relações Interpessoais proposta por Travelbee. Resultados: Quatro categorias emergiram da análise: "Cuidar e acolher pessoas, sentimentos e histórias"; "Reações em meio à dor: transitar entre a aceitação e o sofrimento"; "Comunicação de más notícias: desafios e estratégias"; "O peso do cuidar e do sofrer". Considerações finais: A assistência aos familiares pode ser estabelecida usando-se os princípios de Travelbee, pois oferecem aporte teórico oportuno para ações de enfermagem no contexto do processo de morte e morrer.

A supervisão na formação psicanalítica no modelo Eitingon: história, controvérsias, linhas de desenvolvimento / Supervision in psychoanalytic training in the Eitingon model: history, controversies, developmental lines / Supervisión en la formación psicoanalítica en el modelo Eitingon: historia, controversias, líneas de desarrollo / La supervision dans la formation psychanalytique selon le modèle Eitingon: son histoire, des controverses, des lignes de développement

Um marco essencial na formação psicanalítica é a supervisão de formação. A autora apresenta como e através do que podem se desenvolver a competência e a identidade, ou pode haver um efeito inibidor. Considera a relação emocional entre supervisor e supervisionando durante a supervisão de formação, permeada pelas próprias experiências de aprendizagem e didáticas, carregadas com material inconsciente e ancoradas no âmbito semipúblico do Instituto. Retoma a história da supervisão de formação, descreve a controvérsia quanto a teach or treat e mostra as teorias psicanalíticas mais utilizadas na supervisão. Constata que também nos contextos mais "racionais" se atualiza uma constelação e uma dinâmica relacional emocional, parcialmente inconscientes, entre o supervisionando e o supervisor.

Training supervision is an essential event in psychoanalytic training. This study reveals how and from what competence and identity can be developed, and also if there may be an inhibiting effect. At the same time, it is always about an emotional relationship between supervisor and supervised during the training supervision process, permeated with their own learning and didatics experiences, which are constituted of unconscious material and anchored in the semi-public scope of the Institute. In this paper, the history of training supervision is recapitulated, and its conflict related to the ''teach-or-treat'' controversy is approached. Moreover, a viewpoint on the most used psychoanalytic theories in the supervision process is introduced. Consequently, even in more 'rational' contexts, a constellation, as well as a partially unconscious, emotional relational dynamics between the supervised and the supervisor are always updated.

Un hito esencial en la formación psicoanalítica es la supervisión de la formación. Se presenta aquí cómo y a través de qué competencia e identidad puede desarrollarse, o puede surgir un efecto inhibitorio. Al mismo tiempo, es siempre una relación emocional entre supervisor y supervisionando durante la supervisión de la formación, influenciada por el propio aprendizaje y experiencias didácticas, cargada de material inconsciente y anclada en el ámbito parcialmente público del Instituto. En este artículo se retoma la historia de la supervisión del entrenamiento, se describe su conflicto con la controversia "teach or treat" y se presenta una visión de las teorías psicoanalíticas más utilizadas en la supervisión. De ello se deduce que también en los contextos más "racionales" siempre hay una constelación y una dinámica relacional emocional, parcialmente inconsciente, entre el supervisor y el supervisor.

Une borne essentielle dans la formation psychanalytique, c'est la supervision de formation. On présente ici comment et par quel moyen la compétence et l'identité peuvent se développer, ou il peut y avoir un effet inhibiteur. En même temps, il s'agit toujours d'une relation émotionnelle entre superviseur et supervisé pendant la supervision de formation, transpercée par ses propres expériences d'apprentissage et didactiques, chargées de matériel inconscient et ancrées dans le cadre semi-public de l'Institut. Dans cet article on reprend l'histoire de la supervision de formation, on décrit son conflit par rapport à la controverse "teach or treat" et on présente un panorama des théories psychanalytiques les plus employées en supervision. Le résultat, c'est que dans les contextes les plus « rationnels ¼ on actualise toujours une constellation et une dynamique relationnelle émotionnelle, partiellement inconsciente, entre le superviseur et le supervisé.

Posiciones Mandibulares de Referencia Clínica. Una Descripción Narrativa

RESUMEN: Las posiciones mandibulares se definen como la relación existente entre la mandíbula y la maxila observada durante su función, o bien posiciones de referencia clínica que pueden ser comparables con otras posiciones o movimientos. Se realizó una descripción narrativa de las posiciones de referencia mandibular de mayor interés clínico, donde se definen algunas de sus principales características; (1) la posición de máxima intercuspidación, está definida por el determinante anatómico dentario, tiene una adecuada reproducibilidad y sencilla ejecución, (2) la posición postural mandibular, es la menos estable, y está definida por el determinante fisiológico neuromuscular, siendo el resultado de la interacción de múltiples factores relacionados, (3) la relación céntrica fisiológica, se considera la posición más estable de la mandíbula, siendo repetible e independiente del contacto dentario, (4) la posición retruida ligamentosa, es una posición extrema por lo que no se considera fisiológica, está determinada por la tensión de la banda horizontal medial del ligamento temporomandibular, (5) la posición retruida de contacto, se describe como la posición mandibular cuando se producen los primeros contactos dentarios y la articulación temporomandibular (ATM) está en una posición retruida, se divide en forzada y no forzada, (6) la posición muscular de contacto es una posición regulada a través de diferentes mecanismos que permiten su estabilidad. Estas posiciones brindan una referencia clínica por medio de la cual se pueden evaluar distintos parámetros necesarios para de realizar diagnósticos y planificación de tratamientos, para ello es importante que el profesional tenga los conocimientos adecuados sobre las características que definen cada una de ellas, tales como su estabilidad y reproducibilidad, que son fundamentales al momento de su ejecución.

ABSTRACT: Mandibular positions are defined as the existing relation between mandibula and maxilla during its function, or it can also be defined as clinical reference positions that may be comparable with other positions or movements. A narrative description of the mandibular reference positions of greatest clinical interest was made, where some of their main characteristics were defined; (1) maximum intercuspal position, is defined by de dental anatomical determinant, it has an adequate reproduction and simple execution, (2) the mandibular postural position, it is the least stable, and it is defined by the neuromuscular physiological elements, being the result of the interaction of multiple factors related, (3) the physiological centric relation is considered the most stable position of the mandible, being easy to repeat and independent of dental contact, (4) the retruded ligamentous position, is an extreme position so it is not considered physiological, and it is determinated by the tension of the medial horizontal band of the temporomandibular ligament, (5) retruded contact position is described as the mandibular position when the first dental contacts are produced and the temporomandibular joint (TMJ) is in a retruded position, it is divided into forced and non- forced, (6) the muscular contact position is a position regulated through different mechanisms that allows its stability. These positions provide a clinical reference by means of which different parameters required while diagnosing and planning treatments can be evaluated, this is why it is important for the Specialist to have specific knowledge about the characteristics that correspond to each one of them, such as its stability and reproducibility, which are fundamental at the time of its execution.