Intención de aceptación a la vacunación contra la COVID-19 en sectores vulnerables del Ecuador

Introducción: La COVID-19 causó que varios sectores profesionales hayan tenido que enfrentarlo en primera línea, viéndose afectados ante la vulnerabilidad de contraer el virus. A pesar de la baja tasa de mortalidad de los momentos actuales y la poca saturación de pacientes con COVID-19 en los centros de salud, la aplicación de una cuarta dosis de inoculación ha generado posturas diferentes entre varios países. Objetivo: Determinar si el personal considerado con altos riesgos de vulnerabilidad de la ciudad de Santo Domingo de los Colorados, en Ecuador, tiene intenciones favorables para la aplicación de la cuarta dosis de la vacuna contra la COVID-19. Método: Se desarrolló un estudio cuantitativo de alcance correlacional y diseño transversal. Un cuestionario conformado por 16 preguntas midió las variables: riesgo de contagio, conocimiento percibido sobre la vacuna, confianza sobre la vacuna e intención de vacunarse; el cual fue aplicado a 375 participantes. Los análisis estadísticos fueron desarrollados a través de Excel y Statistical Package for Social Sciences 21 (SPSS 21). Resultados: Los análisis estadísticos evidenciaron que el riesgo de contagio (β=0,178**), el conocimiento percibido sobre la vacuna (β=0,218**) y la confianza sobre la vacuna (β=0,192**) se correlacionan significativamente con la intención de vacunarse, ante lo cual se evidencia la necesidad de recibir una cuarta dosis de inoculación por parte de los sectores vulnerables. Conclusiones: Esta es la primera investigación que expone resultados respecto a la intención de vacunación en las personas vulnerables y pone en evidencia la intención de acceder a una cuarta dosis de inoculación.

Introduction: COVID-19 caused healthcare professional workers have faced the pandemic on the frontline at the risk of being infected with the virus. Despite the low mortality rate at present and the low presence of patients with COVID-19 in health care centers, the application of a fourth booster dose has generated different positions among several countries. Objective: To determine whether personnel considered being at high risk of vulnerability in the city of Santo Domingo de los Colorados, Ecuador, have favorable intentions for receiving the fourth booster dose of the COVID-19 vaccine. Method: A quantitative study of correlational scope and cross-sectional design was developed. A questionnaire consisting of 16 questions measured the following variables: risk of infection, perceived knowledge of the vaccine, confidence in the vaccine and intention to be vaccinated; this questionnaire was applied to 375 participants. Statistical analyses were developed using the microsoft Excel spreadsheed and Statistical Packagefor Social Sciences 21 (SPSS 21). Results: Statistical analyses showed that the risk of infection (β=0.178**), perceived knowledge about the vaccine (β=0.218**) and confidence about the vaccine (β=0.192**) are significantly correlated with the intention to be fully vaccinated, thus showing the need for a fourth booster dose by vulnerable sectors. Conclusion: This is the first research that presents results regarding the intention to vaccinate vulnerable people and highlights the intention to access a fourth booster dose.

Introdução: O COVID-19 fez com que diversos setores profissionais o enfrentassem na linha de frente, sendo afetados pela vulnerabilidade de contrair o vírus. Apesar da baixa taxa de mortalidade atual e da baixa saturação de pacientes com COVID-19 nos centros de saúde, a aplicação de uma quarta dose de inoculação gerou posições diferentes entre vários países. Objetivo: Determinar se o pessoal considerado de alto risco de vulnerabilidade na cidade de Santo Domingo de los Colorados, no Equador, tem intenções favoráveis para a aplicação da quarta dose da vacina contra COVID-19. Método: Foi desenvolvido um estudo quantitativo com escopo correlacional e delineamento transversal. Um questionário composto por 16 questões mediu as variáveis: risco de contágio, conhecimento percebido sobre a vacina, confiança sobre a vacina e intenção de se vacinar; que foi aplicado a 375 participantes. As análises estatísticas foram realizadas no Excel e no Statistical Package for the Social Sciences 21 (SPSS 21). Resultados: As análises estatísticas mostraram que o risco de contágio (β=0,178**), o conhecimento percebido sobre a vacina (β=0,218**) e a confiança sobre a vacina (β=0,192**) estão significativamente correlacionados com a intenção de ser vacinado, o que evidencia a necessidade de receber uma quarta dose de inoculação por setores vulneráveis. Conclusões: Esta é a primeira pesquisa que expõe resultados sobre a intenção de vacinação em pessoas vulneráveis e evidencia a intenção de acessar uma quarta dose de inoculação.

Cognition of prevention and control of cervical cancer and influencing factors of HPV vaccination intention among college students in Xiangyang / 公共卫生与预防医学

Objective The knowledge of cervical cancer prevention and control，the cognition of human papillomavirus (HPV) vaccine and the willingness to vaccinate HPV vaccine among college students in Xiangyang were investigated and analyzed to provide a reliable scientific basis for the primary prevention of cervical cancer prevention and control in Xiangyang. Methods By means of stratified sampling method and self-made questionnaire, this paper conducted a questionnaire survey among college students in 3 universities in Xiangyang. Results A total of 8 523 college students participated in the questionnaire survey, and 4 473 of them had sufficient knowledge of cervical cancer prevention and control and HPV vaccine, with the awareness rate of 52.48%. Male students, rural residents and non-medical majors were the influencing factors of insufficient knowledge of cervical cancer prevention and control and HPV vaccine. Among the 6 459 female college students who participated in the survey, 5,993 (92.79%) were willing to be vaccinated, and 859 (13.30%) were already vaccinated. Major, educational background, living expenses and cognitive scores were the influencing factors of HPV vaccination intention. Conclusion College students in Xiangyang City are relatively deficient in the knowledge of cervical cancer prevention and control and HPV vaccine. Targetable science popularization and education can improve college students' correct understanding of cervical cancer prevention and control knowledge, promote the HPV vaccine vaccination plan, and reduce the occurrence of HPV-related diseases and cervical cancer.

Caracterização atual da objeção de consciência: proposta crítica e renovada / Current characterization of conscientious objection: a critical and renewed proposal / Caracterización actual de la objeción de conciencia: propuesta crítica y renovada

Resumo O artigo caracteriza a "objeção de consciência" - cercada por controvérsias e marcada pela ausência de definição unificada - e os limites de seu exercício. O objetivo da pesquisa, baseada na abordagem de revisão crítica de literatura, é propor uma definição para o termo. Para isso, identificaram-se situações em que a objeção de consciência é erroneamente invocada ou serve de pretexto para comportamentos antiéticos, e se procurou estabelecer os elementos que verdadeiramente compõem tal objeção. O conceito proposto pretende contribuir para esclarecer o assunto e estabelecer limites justos ao exercício ético desse direito.

Abstract This article characterizes "conscientious objection" - surrounded by controversies and marked by the absence of a unified definition - and the limits of its exercise. From a critical literature review approach, the objective is to propose a definition for the term. For such, situations where conscientious objection is wrongly invoked or serves as a pretext for unethical behavior were identified, and an attempt to establish the elements that truly compose such objection was made. The proposed concept intends to contribute to clarifying the matter and establishing fair limits to the ethical exercise of this right.

Resumen El artículo caracteriza la "objeción de conciencia", rodeada de controversias y marcada por la ausencia de una definición unificada, y los límites de su ejercicio. El objetivo de la investigación, basada en el enfoque de la revisión crítica de la literatura, es proponer una definición para el término. Para ello, se identificaron situaciones en las que la objeción de conciencia se invoca erróneamente o sirve de pretexto para conductas poco éticas, y se intentó establecer los elementos que verdaderamente componen dicha objeción. El concepto propuesto pretende contribuir a clarificar el tema y establecer límites justos al ejercicio ético de este derecho.

Sistema de gestión TO-BE: garantizar el derecho a la salud de pacientes con ITS en Perú / TO-BE management system: guaranteeing the right to health of patients with STIs in Peru

Se realizó una investigación de campo para conocer la gestión de los procesos de solicitud y admisión de citas médicas, considerando la estigmatización y discriminación de las personas ITS, con el fin de garantizar el derecho a la salud de estos pacientes en Perú. Se ejecutó la sistematización de la información sobre los procesos y mecanismos de exigibilidad, bajo los lineamientos y manuales de los cuatro procesos estratégicos del MINSA contemplados para el otorgamiento de citas médicas, siguiendo los lineamientos de Gob.Pe, Adicionalmente, mediante verificación de los procesos se construyeron la matriz entidad-relación de la gestión por procesos del SSP, y el flujograma del proceso de solicitud y otorgamiento de citas AS-ISS. Se consideraron aspectos tecnológicos-médicos-legales con la participación de 201 pacientes independientemente del motivo o patología a consultar, identificando incidentes en la eficiencia del proceso misional. Por último, se implementó el flujograma de procesos de reserva de citas médicas a través de la aplicación ejecutable para smartphones, tabletas y otros dispositivos móviles (APP) TO-BE la cual conlleva a 10 pasos desde el registro de usuario hasta la emisión de comprobante de otorgamiento de cita médica. Se analizaron las preferencias de los usuarios sobre las causas superables en el proceso misional, mediante una encuesta estructura a 170 usuarios de SSP(AU)

A field investigation was carried out to learn about the management of the processes of request and admission of medical appointments, considering the stigmatization and discrimination of STI people, in order to guarantee the right to health of these patients in Peru. The systematization of the information on the processes and mechanisms of enforceability was carried out, under the guidelines and manuals of the four strategic processes of the MINSA contemplated for the granting of medical appointments, following the guidelines of Gov. Pe, Additionally, through verification of the processes The entity-relationship matrix of the management by processes of the SSP, and the flowchart of the process of request and granting of appointments AS-ISS were constructed. Technological-medical-legal aspects were considered with the participation of 201 patients regardless of the reason or pathology to be consulted, identifying incidents in the efficiency of the missionary process. Finally, the flowchart of medical appointment reservation processes was implemented through the executable application for smartphones, tablets and other mobile devices (APP) TO-BE, which entails 10 steps from user registration to issuance of voucher of granting a medical appointment. Users' preferences regarding causes that can be overcome in the missionary process were analyzed through a structured survey of 170 SSP users(AU)

Aportes del uso de Simuladores educativos en aula como una herramienta para mejorar la calidad del aprendizaje de los alumnos de la Facultad de Psicología de la UAQ / Contributions of the use of educational simulators in the classroom as a tool to improve the quality of learning in the students of the faculty of psychology of the UAQ

Dentro de este magnífico mundo de enseñanza ­aprendizaje existen muchos elementos de influencia más allá de solo un maestro, un alumno o un aula; crear ambientes de aprendizaje dinámicos, efectivos y orientados a la generación de aprendizaje significativo es tarea de todos los profesionales de la educación; para ello debemos romper esquemas, modelos anacrónicos y pensar en estrategias propositivas adaptadas a las nuevas y diferentes formas de aprender de las generaciones actuales y futuras creando entornos amigables, prácticos y efectivos. Este artículo plantea la utilización de simuladores en los ámbitos educativos, como una forma de facilitar el aprendizaje mediante el uso de los métodos y herramientas de transmisión de conocimiento adaptadas a las necesidades de aprendizaje actuales, es decir, de explotar las herramientas propias de la época en la que vivimos; en este caso las tecnológicas; esto se vuelve necesario considerando que tanto los métodos de enseñanza ­aprendizaje, como los sistemas educativos de hoy en día, ya no son del todo suficientes para cubrir las expectativas de educación actuales, debido a que hoy en día en muchos países aún se siguen utilizando métodos y estrategias educativas diseñadas para cubrir las necesidades de las sociedades del siglo pasado. En este documento se habla sobre la necesidad actual de contar con herramientas que potencialicen la calidad y efectividad del proceso de enseñanza ­aprendizaje en las aulas y de la propuesta de un método de investigación participativa en la cual es posible identificar cómo la implementación de herramientas TIC por medio del uso de simuladores en aula, es efectiva y benéfica para mejorarla adquisición y dominio de conocimiento en los estudiantes de la licenciatura de Psicología del trabajo de la Universidad Autónoma de Querétaro, logrando en ellos un mejor desempeño profesional y mayor éxito en las actividades propias de su profesión.

Around the magnific world of the teaching -learning, exist many influencing elements more than the only a professor, a student or an classroom; work to make a dynamic and effective learning environments and oriented to create significative learning is a job of all the professionals of learning, to do that, we have to broke schemes, anachronic models and think In propositives strategies aligned to the new and different ways of learn of the actually and future generations, creating friendly, practical and effective environments. This article proposes the use of simulator systems in educational environments, is a way to facilitate the learning through the use of methods and tools to help the transmission of knowledge adapted to current learning needs, that is to, exploit the modern tools; the technology tools. That becomes necessary considering that both the teaching ­learning methods and the actually educational systems, are very far from covering the current education expectations and needs because in many countries are using educational methods and strategies designed to comply the needs of the last century societies. This article, talk about the current need to count with tools that enhance the quality and effectiveness of the teaching -learning process in the classrooms and the proposal of a participatory investigation method with which is possible to identify how the implementation of TIC tools across the use of simulators in classroom is effective and beneficial to get better and acquire mastery of learning on the psychology students of autonomous university of Querétaro, achieving a better professional performance in them and greater success in professional activities.

The right to be forgotten and COVID-19: privacy versus public interest / El derecho al olvido y el COVID-19: privacidad frente a interés público / O direito ao esquecimento e COVID-19: privacidade versus interesse público

Abstract: Recent studies highlight the importance of digital surveillance to gather individual health information due to the global pandemic caused by the new COVID-19 disease. This paper analyses its legal and ethical implications at the interface between the individual right to privacy and the collective interests of public health. We framed the discussion in law, deontology and utilitarianism. The lasted theories and human rights, especially privacy, are crucial in our argument. Health-derived dilemmas and efforts to solve them, especially by information technologies, bioethics and law, exist at these perspectives' interface. In particular, we analysed the intersection between autonomy, the right to privacy, and the so-called 'right to be forgotten' in the public health context. In other words, we studied the right to obtain from the controller the erasure of health data - a radical means of control over personal data established in Article 17 of the General Data Protection Regulation (GDPR). Given the lack of specifics regarding collection and re-use of such data under the broad scope of public health purposes, implied consent does not address the issue of proportionality. We highlight legal safeguards' insufficiency, suggesting applying the 'right to be forgotten' according to an ethical interpretation.

Resumen: Estudios recientes destacan la importancia de la vigilancia digital para recoger información sanitaria individual debido a la pandemia mundial causada por la nueva enfermedad COVID-19. Este artículo analiza sus implicaciones legales y éticas en la interfaz entre el derecho individual a la privacidad y los intereses colectivos de la salud pública. Enmarcamos la discusión en el derecho, la deontología y el utilitarismo. Estas últimas teorías y los derechos humanos, especialmente la privacidad, son cruciales en nuestro argumento. Los dilemas relacionados con la salud y los esfuerzos por resolverlos, especialmente a través de la tecnología de la información, la bioética y el derecho, se encuentran en la interfaz de estas perspectivas. En particular, analizamos la intersección entre la autonomía, el derecho a la privacidad y el llamado "derecho al olvido" en el contexto de la salud pública. Es decir, estudiamos el derecho a obtener del responsable del tratamiento la supresión de los datos de salud, un medio radical de control sobre los datos personales establecido en el artículo 17 del Reglamento general de protección de datos (RGPD). Dada la falta de especificidades en cuanto a la recogida y reutilización de dichos datos dentro del amplio ámbito de los objetivos de salud pública, el consentimiento implícito no aborda la cuestión de la proporcionalidad. Destacamos la insuficiencia de las garantías legales, sugiriendo la aplicación del "derecho al olvido" según una interpretación ética.

Resumo: Estudos recentes salientam a importância da vigilância digital para recolher informações individuais de saúde devido à pandemia global causada pela nova doença COVID-19. Este artigo analisa as suas implicações legais e éticas na interface entre o direito individual à privacidade e os interesses coletivos da saúde pública. Enquadramos a discussão no direito, na deontologia e no utilitarismo. As últimas teorias e os direitos humanos, especialmente a privacidade, são cruciais na nossa argumentação. Dilemas derivados da saúde e esforços para os resolver, especialmente através das tecnologias da informação, da bioética e do direito, existem na interface destas perspetivas. Em particular, analisámos a intersecção entre autonomia, direito à privacidade, e o chamado "direito ao esquecimento" no contexto da saúde pública. Por outras palavras, estudámos o direito de obter do responsável pelo tratamento o apagamento dos dados de saúde, um meio radical de controlo dos dados pessoais estabelecido no artigo 17º do Regulamento Geral de Proteção de Dados (RGPD). Dada a falta de especificidades em relação à recolha e reutilização de tais dados no âmbito alargado dos objetivos de saúde pública, o consentimento implícito não aborda a questão da proporcionalidade. Destacamos a insuficiência de salvaguardas jurídicas, sugerindo a aplicação do "direito ao esquecimento" de acordo com uma interpretação ética.

The right to be forgotten versus the right to disclosure of gamete donors' id: ethical and legal considerations / El derecho al olvido frente al derecho a revelar la identificación de los donantes de gametos: consideraciones éticas y jurídicas / O direito ao esquecimento versus o direito à divulgação da identificação de dadores de gâmetas: considerações éticas e legais

Abstract: 15. The anonymity of gamete donors in the context of medically-assisted reproduction techniques (ART) and the right of the offspring to know their genetic or biological parents' identity is a controversial and widely debated topic in the scientific literature. The positions on the issue in each country are different. Sometimes they are in opposition to each other even in countries with strong similarities, such as those in the European Union (EU), in the framework of shared ethical values. Although some countries still enshrine the rule of anonymity, there is an undeniable tendency to guarantee the right to know one's origins by creating relevant exceptions or abolishing donor anonymity status altogether. 16. This article offers ethical and legal considerations of whether the so-called 'right to be forgotten' (RTBF) could be extended to include gamete donors' right to remain anonymous. This perspective goes against the general trend, certainly in Europe, of recognizing that offspring born from donor gametes have a right to access information relating to their genetic progenitors. The novel addition is to question whether the General Data Protection Regulation (GDPR) might provide fertile ground for questioning this approach, and effectively support those jurisdictions where anonymity is still possible.

Resumen: 20. El anonimato de los donantes de gametos en el contexto de las técnicas de reproducción médicamente asistida (RM) y el derecho de la descendencia a conocer su identidad genética o biológica es un tema controvertido y ampliamente debatido en la literatura científica. Las posiciones sobre el tema en cada país son diferentes. A veces se oponen entre sí, incluso en países con fuertes similitudes, como los de la Unión Europea (UE), en el marco de valores éticos compartidos. Aunque algunos países siguen consagrando la norma del anonimato, es innegable la tendencia a garantizar el derecho a conocer el propio origen creando las excepciones pertinentes o suprimiendo por completo el estatus de anonimato del donante. 21. Este artículo ofrece consideraciones éticas y jurídicas sobre si el llamado "derecho al olvido" podría ampliarse para incluir el derecho de los donantes de gametos a permanecer en el anonimato. Esta opinión es contraria a la tendencia general, ciertamente en Europa, de reconocer que los hijos nacidos de gametos donados tienen derecho a acceder a la información relativa a sus padres genéticos. La nueva adición consiste en debatir si el Reglamento general de protección de datos (RGPD) podría proporcionar un terreno fértil para cuestionar este enfoque y apoyar efectivamente a las jurisdicciones en las que el anonimato sigue siendo posible.

Resumo 25. O anonimato dos dadores de gâmetas no contexto das técnicas de reprodução medicamente assistida (RMA) e o direito da descendência a conhecer a sua identidade genética ou biológica é um tema controverso e amplamente debatido na literatura científica. As posições sobre a questão em cada país são diferentes. Por vezes estão em oposição umas às outras, mesmo em países com fortes semelhanças, como os da União Europeia (UE), no quadro de valores éticos partilhados. Embora alguns países ainda consagrem a regra do anonimato, existe uma tendência inegável para garantir o direito de conhecer as suas origens, criando exceções relevantes ou abolindo completamente o estatuto de anonimato dos dadores. 26. Este artigo oferece considerações éticas e legais sobre se o chamado "direito ao esquecimento" poderia ser alargado para incluir o direito dos dadores de gâmetas a permanecerem anónimos. Esta perspetiva vai contra a tendência geral, certamente na Europa, de reconhecer que os descendentes nascidos de gâmetas doadas têm o direito de aceder à informação relacionada com os seus progenitores genéticos. O novo aditamento é debater se o Regulamento Geral de Proteção de Dados (RGPD) poderá fornecer um terreno fértil para questionar esta abordagem, e apoiar efetivamente as jurisdições onde o anonimato ainda é possível.

Reflexos da (in)capacidade de estar só em tempos de isolamento social na pandemia COVID-19 / Reflections of the (in)ability to be alone in times of social isolation in pandemia COVID-19

As medidas adotadas em diversos países, necessárias como tentativa de contenção da pandemia causada pelo novo coronavírus (COVID-19), desencadearam mudanças radicais no dia a dia dos indivíduos, ocasionando sentimentos de incerteza, angústia, ansiedade e depressão na população em geral. O aumento do sentimento de solidão levou muitos indivíduos a utilizarem recursos internos e pôs à prova a capacidade de estar só. Alguns conceitos psicanalíticos evidenciam que o indivíduo que atinge um ego integrado, através de cuidados maternos suficientemente bons nos momentos primitivos, como bebê, adquire a capacidade de estar só. Isso ressalta a importância das primeiras relações objetais para a construção de um mundo interno satisfatório. Em contrapartida, a interrupção desse amadurecimento emocional pode despertar no sujeito adulto a utilização de mecanismos de ordem externa, como diversos tipos de adições, exposição a comportamentos de risco e, provavelmente, no caso da pandemia, desrespeito às medidas de distanciamento social. Diante disso, observa-se quão importante é o desenvolvimento saudável das primeiras relações objetais para que o indivíduo seja capaz de lidar com a solidão, e adote estratégias saudáveis ao longo da vida, inclusive em situações críticas. Assim, esse artigo se propõe a revisar alguns aspectos da teoria psicanalítica sobre a capacidade de estar só dentro do desenvolvimento emocional e compreender as consequências psíquicas resultantes das falhas nessa etapa da vida psíquica dos indivíduos.(AU)

The measures adopted in several countries, necessary as an attempt to contain the pandemic caused by the new coronavirus (COVID 19), triggered radical changes in the daily lives of individuals, causing feelings of uncertainty, anguish, anxiety and depression in the general population. The increased feeling of loneliness has led many individuals to use internal resources and test their ability to be alone. Some psychoanalytic concepts show that the individual who reaches an integrated ego, through maternal care good enough in primitive moments, as a baby, acquires the ability to be alone. This underscores the importance of early object relations for building a satisfying inner world. On the other hand, the interruption of this emotional maturation can awaken in the adult the use of external mechanisms, such as various types of addictions, exposure to risky behaviors and probably, in the case of the pandemic, disrespect to the measures of social distancing. Therefore, it is observed how important the healthy development of the first object relations is for the individual to be able to deal with loneliness, and to adopt healthy strategies throughout life, including in critical situations. Thus, this article set out to review some aspects of psychoanalytic theory about the ability to be alone within emotional development and to understand the psychic consequences resulting from failures in this stage of the psychic life of individuals.(AU)

Las medidas adoptadas en varios países, necesarias como intento de contener la pandemia por el nuevo coronavirus (COVID 19), desencadenaron cambios radicales en la vida cotidiana de las personas, causando sentimientos de incertidumbre, angustia, ansiedad y depresión en la población en general. El aumento de la sensación de soledad ha llevado a muchas personas a utilizar recursos internos y ha puesto a prueba la capacidad de estar solos. Algunos conceptos psicoanalíticos muestran que el individuo que alcanza un ego integrado, a través del cuidado materno suficientemente bueno en momentos primitivos, como un bebé, adquiere la capacidad de estar solo. Esto resalta la importancia de las primeras relaciones de objeto para la construcción de un mundo interno satisfactorio. Por otro lado, la interrupción de esta maduración emocional puede despertar en el sujeto adulto el uso de mecanismos externos, como varios tipos de adicciones, la exposición a conductas de riesgo y probablemente, en el caso de la pandemia, la falta de respeto a las medidas de distanciamiento social. Por lo tanto, se observa cuán importante es el sano desarrollo de las primeras relaciones de objeto para que el individuo sea capaz de afrontar la soledad y adoptar estrategias saludables a lo largo de la vida, incluso en situaciones críticas. Así, este artículo se propuso revisar algunos aspectos de la teoría psicoanalítica sobre la capacidad de estar solo dentro del desarrollo emocional y comprender las consecuencias psíquicas derivadas de los fracasos en esta etapa de la vida psíquica de los individuos.(AU)

El sujeto según Sartre y Lacan. Encuentros y desencuentros entre fenomenología y psicoanálisis / The subject according to Sartre and Lacan. Encounters and disagreements between phenomenology and psychoanalysis

Este trabajo consiste en comparar el concepto de sujeto propuesto por Jacques Lacan al psicoanálisis con la concepción de subjetividad que puede deducirse de la obra de Jean-Paul Sartre que da lugar a su propuesta de un psicoanálisis existencial

This work consists of comparing the concept of subject proposed by Jacques Lacan to psychoanalysis with the conception of subjectivity that can be deduced from the work of Jean-Paul Sartre that gives rise to his proposal of an existential psychoanalysis

Só... Solidão...: Fronteiras entre a curva e a reta / Alone... Loneliness: borders between curve and straight / Solo... soledad...: fronteras entre curva y recta / Seul... solitude...: limites entre la courbe et la ligne

Com base no poema de Manoel de Barros "A reta é uma curva que não sonha", a autora descreve a capacidade de estar só, como uma série de curvas em espiral, e o sentimento de solidão, como uma reta sem curvas. Apoia-se em Winnicott, Bion e Klein. Ilustra com o caso de uma família haitiana atendida no setting da clínica transcultural e com o de um menino de 1 ano e 11 meses com indicadores de risco de desenvolvimento atendido no setting clássico de psicanálise com crianças. Assim, nas duas situações clínicas, apresenta como alternativa aos caminhos retilíneos, os caminhos sinuosos, pelos quais a construção de capacidade de estar só tem sido possível, sem que os elementos de angústia mais submersos e profundos sejam caçados ostensivamente, mas possam tomar corpo na sessão e, progressivamente, vir à tona, para serem transformados. Finaliza com uma história infantil que retrata o universo emocional da criança quando falha a relação de intimidade mãe-bebê. Nesta história a mãe reconhece suas falhas e repara os vínculos esgarçados, uma mamãe que tece as emoções promovendo um encontro emocional.

From "The line is a dream without curve", a Manoel de Barros' poem, the author describes the capacity to be alone as a series of spiral curves, and the feeling of loneliness as a straight line without curves. It relies on Winnicott, Bion and Klein. It illustrates with the attendance of a Haitian family attended in the setting of the transcultural clinic and the case of a boy (1 year and 11 months) with indicators of developmental risk attended in the psychoanalysis setting with children. Thus, in both clinical situations, it presents, as an alternative to the rectilinear paths, the winding paths, through which the building of being capacity has only been possible, without the most submerged and deep distress elements being hunted ostensibly, but can take shape and, progressively, have occasion to be transformed. It ends with a children's story that portrays the child's emotional universe when the mother-baby relationship fails. In this story the mother recognizes her flaws and repairs the broken bonds, a mother who weaves her emotions promoting an emotional encounter.

Del poema "La línea es una curva sin sueños", de Manoel de Barros, el autor describe la capacidad de estar solo como una serie de curvas en espiral, y el sentimento de soledad como una línea recta sin curvas. Se basa en Winnicott, Bion, Klein y Quinodoz. Ilustra con el cuidado de una familia haitiana atendida en el setting de la clínica transcultural y con el caso de un niño de 1 año y 11 meses con indicadores de riesgo de desarrollo atendido en el setting de psicoanálisis con niños. Por lo tanto, en ambas situaciones clínicas, presenta, como una alternativa a los caminos rectilíneos, los caminos sinuosos, a través de los cuales la construcción de la capacidad solo ha sido posible, sin que los elementos de busca más profundos y sumergidos sean cazados aparentemente, pero pueden tomar forma y, progressivamente, se destacan y tienen ocasión de transformarse. Termina con una historia infantil que retrata el universo emocional del niño cuando la relación madre-bebé falla. En esta historia, la madre reconoce sus defectos y repara los lazos rotos, una madre que teje sus emociones promoviendo un encuentro emocional.

À partir du poème de Manoel de Barros « La droite est une courbe qui ne rêve pas ¼, l'auteur décrit la capacité d'être seul, comme une série de courbes en spirale, et le sentiment de solitude, comme une droite sans courbes. Il s'appuie sur Winnicott, Bion et Klein. Il illustre avec la prise en charge d'une famille haïtienne servie dans le cadre de la clinique interculturelle et le cas d'un garçon de 1 an et 11 mois avec des indicateurs de risque de développement assisté dans le cadre de la psychanalyse avec enfants. Ainsi, dans les deux situations cliniques, il se présente comme une alternative aux chemins rectilignes, les chemins sinueux, à travers lesquels la construction de la capacité à être n'a été que possible, sans que les éléments d'angoisse les plus submergés et profonds soient ostensiblement chassés, mais ils peuvent prendre forme dans le session et progressivement surface, à transformer. Il se termine par une histoire pour enfants qui dépeint l'univers émotionnel de l'enfant lorsque la relation mère-bébé échoue. Dans cette histoire, la mère reconnaît ses défauts et répare les liens brisés, une mère qui tisse les émotions favorisant une rencontre émotionnelle.

La obligación de informar y el consentimiento informado en Odontología: una mirada crítica más allá de la regulación normativa / Right to be informed and informed consent in Dentistry: A critical look beyond law regulation / A obrigação de informar e o consentimento informado em Odontologia: uma visão crítica para além da regulação normativa

Resumen El presente trabajo tiene por finalidad mostrar que la regulación normativa chilena de la obligación de informar y el consentimiento informado en Odontología no resultan suficientes para un apropiado ejercicio de tales derechos. Para ello describe en qué consisten tales obligaciones, considerando aspectos históricos y doctrinarios, y analiza el derecho a ser informado y el consentimiento informado haciendo énfasis en su finalidad y utilidad. Detalla además, de manera crítica y pormenorizada, la actual regulación chilena sobre la materia y aspectos de la práctica odontológica en materia de consentimiento informado. En último término, propone soluciones para superar los inconvenientes encontrados.

Abstract This article aims to make clear that the Chilean regulation of the right to be informed and informed consent in Dentistry is not sufficient for the proper exercise of such rights. To do this, it begins by describing this obligations, considering historical and doctrinal aspects. It continues to analyze the right to be informed and informed consent, emphasizing its purpose and usefulness. Subsequently, the current Chilean regulation on the matter is critically detailed, to finish exposing aspects of dental practice in the field of informed consent. Lastly, some solution proposals for overcoming the problems found are indicated.

Resumo O presente trabalho tem por finalidade mostrar que a regulação normativa chilena da obrigação de informar e do consentimento informado em Odontologia não é suficiente para um exercício apropriado de tais direitos. Para isto, descreve no que consistem tais obrigações, considerando aspectos históricos e doutrinários, e analisa o direito a ser informado e o consentimento informado dando ênfase na sua finalidade e utilidade. Além disto, detalha de maneira crítica e pormenorizada a atual regulação chilena sobre o tema e aspectos da prática odontológica em termos de consentimento informado. Por fim, propõe soluções para superar os inconvenientes encontrados.

La Capacidad Para Estar Solo / The Capacity To Be Alone

Resumen Donald Winnicott fue uno de los más notables autores psicoanalíticos del siglo pasado. Uno de sus artículos más citados es "La capacidad del estar solo" de 1958. En él expone que dicha capacidad es uno de los signos más importantes de madurez psíquica y que su adquisición paulatina depende de haber podido establecer, primero, una relación bipersonal con su madre -o con quien fuese que ejerza dicho rol- de tal manera de haber ido construyendo una relación no amenazante consigo mismo, donde pueda contemplarse en armonía y sin la necesidad de reaccionar. En este interjuego de auto-observación va surgiendo paso a paso el yo, que es la instancia consciente que observa el despliegue del self. Plantea el concepto de "orgasmo del yo" entendiéndolo como un estado placentero pero sin excitación sexual ni necesidad de descarga física. Cuando se está a solas consigo mismo, lo que no implica necesariamente estar físicamente solo, pueden expresarse aquellas particularidades que construirán una personalidad adulta y en armonía consigo mismo.

Donald Winnicott was one of the most remarkable psychoanalytic authors of the last century. One of his most cited articles is "The capacity to Be alone" from 1958. In it he states that this ability is one of the most important signs of psychic maturity and that its gradual acquisition depends on having been able to establish, first, a bipersonal relationship with his mother -or with whoever exercises that role- in such a way that he has been building a non-threatening relationship with himself, where he can contemplate himself in harmony and without the need to react. In this interplay of self-observation, the ego, which is the conscious instance that observes the unfolding of the self , emerges step by step. It raises the concept of "orgasm of the ego", understanding it as a pleasant state but without sexual excitement or the need for physical discharge. When you are alone with yourself, which does not necessarily mean being physically alone, you can express those particularities that will build an adult personality and in harmony with yourself,

An evaluation of safety and efficacy of nadifloxacin 1% ointment versus mupirocin 1% ointment in Indian children with skin and soft tissue infection

Background: Although nadifloxacin has been shown to be effective in the treatment of skin & soft tissue infections (SSTI), there is a paucity of data comparing its efficacy and safety with other antibacterials, especially in Indian paediatric population. Therefore, objective of this study was to compare the safety and efficacy of nadifloxacin with mupirocin in children with SSTI.Methods: This was a single-centre, open label, randomized, parallel group, comparative study in 60 children of <12 years of age with SSTI. Test group (n=30) received nadifloxacin 1% ointment and reference group (n=30) received mupirocin 1% ointment, to be applied twice daily. Patients were followed up at day 4, 8 and 15. Efficacy of the study drugs was evaluated by clinical and bacteriological cure rate. Safety was assessed by reporting of adverse events.Results: Baseline characteristics of enrolled patients were comparable between treatment groups and all 60 patients completed the study. At Day 15, 100.0% cases among nadifloxacin group and 96.7% cases among mupirocin group achieved clinical cure (p=0.313). The most common bacteria found in culture were Gram positive cocci in both the groups (86.7% in nadifloxacin and 58.8% in mupirocin group). None of the cases in any of the groups showed bacteriological presence at day 15. No adverse event was reported in any of the treatment groups during the study duration.Conclusions: Nadifloxacin was found to be equally efficacious and safe to mupirocin in the treatment of SSTI in Indian pediatric population.

Sociodemographic and Psychological Factors as Predictors of Body Mass Index-for-Age (BAZ) among Adolescents in Sibu, Malaysia

@#Introduction: Understanding childhood obesity becomes vital as a tremendous increase in the prevalence of overweight/obesity among children and adolescents was observed. This cross-sectional study aimed to investigate the associations between sociodemographic and psychological characteristics with body-mass-index-for-age (BAZ) among adolescents in Sibu, Sarawak. Methods: A total of 375 students (32.0% males and 68.0% females; 15-17 years old) at four randomly selected public secondary schools were recruited. A questionnaire on sociodemographic and psychological characteristics (self-efficacy for physical activity, weight management, and nutrition, body discrepancy score, and sociocultural pressure to be thin) were used to gather information. Body weight and height were also assessed. Results: Around 18.6% respondents were found to be overweight/obese while nearly 5.0% were categorized as thin. In multiple linear regression, three significant predictors, namely body discrepancy score, being Iban (Reference: Chinese) and sociocultural pressure to be thin explained 45.1% of the variance in BMI-for-age z-score. Conclusion: Future interventions on adolescent body weight management should consider incorporating sociodemographic and psychological factors such as the development of positive body image, uniqueness in cultural value, and management of perceived sociocultural pressures to increase their effectiveness

Prácticas pa ra la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia) / Practices for the prevention of accidents in the home in caregivers of children from 1 to 5 years in a district of Cartagena (Colombia)

Introducción: los accidentes en la población infantil constituyen una importante causa de morbilidad y mortalidad convirtiéndose hoy día en un problema de salud pública mundial, principalmente la población más afectada son los niños en etapa preescolar, por la vulnerabilidad y dependencia del cuidador. Objetivos: describir las prácticas para la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia). Materiales y métodos: estudio cuantitativo descriptivo transversal. Constituido por 354 cuidadores de niños menores de 5 años, se utilizó la técnica de observación y la aplicación del instrumento con base a la práctica N° 15 de AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia). Resultados: socio demográficamente los cuidadores fueron principalmente de género femenino (87%), con 20 ­ 29 años de edad (44,9%), madres de los niños (61,3%), conviven en unión libre (54,2%), son bachilleres (50,3%), de estrato uno (91,8%), amas de casa (62,7%), con hijos (93,8%), residen en casas (54,5%). Los niños de 1 a 5 años fueron mayoritariamente de género masculino (51,7%), y han presentado accidentes (75,1%), sobre todo, caídas (61,9%). El nivel de riesgo de accidentes en el hogar fue bajo (85%), y las prácticas de prevención suelen ser regulares (55,1%). Conclusión: los niños enfrentan relativamente bajo riesgo de accidente en el hogar, sin embargo, las prácticas para prevenirlos resultan ser regulares..(AU)

Introduction: accidents in children are an important cause of morbidity and mortality,becoming today a global public health problem, mainly the most affected population are children in preschool, for the vulnerability and dependence of the caregiver. Objectives:to describe the practices for the prevention of accidents at home in caregivers of children from 1 to 5 years of age, in a neighborhood of Cartagena (Colombia). Materials and methods: quantitative, descriptive and cross-sectional study. Consisting of 354 caregivers of children under 5 years of age, the technique of observation and the application of the instrument was used based on practice No. 15 of IMCI (Integrated Management of Childhood Illness). Results: demographic partner caregivers were mainly female (87%), with 20 - 29 years of age (44.9%), mothers of children (61.3%), live together in a free union (54.2%), are high school graduates (50.3%), of stratum one (91.8%), housewives (62.7%), with children (93.8%), reside in houses (54.5%). Children from 1 to 5 years old were male (51.7%), and had accidents (75.1%), especially falls (61.9%). The level of accident risk in the home was low (85%), and prevention practices are usually regular (55.1%). Conclusion: children face relatively low risk of accident in the home, however, practices to prevent them turn out to be regular..(AU)

Factors associated with compliance to guidelines on the use of antibiotics and correlated with clinical outcomes of pregnant women admitted in the Department of Obstetrics and Gynecology of a tertiary hospital from January 1, 2018 to December 31, 2018

BACKGROUND@#Antimicrobial therapy is an integral part of an acceptable clinical practice in Obstetrics and Gynecology. However, in order for these antimicrobials to deliver the desired clinical outcome, the practice of judicious antibiotic stewardship should be observed. The objective of the study was 1.) To determine the proportion of pregnant women admitted at the Department of Obstetrics and Gynecology who received antibiotics from January 1, 2018 to December 31, 2018, 2.) To determine the proportion of indications for antibiotic administration, 3.) To determine if indications for antimicrobial usage is in accordance with the clinical case, policy guidelines, culture results and antibiogram report, 4.) To determine the percentage of cases not given antimicrobials that should have been started on antimicrobial therapy, 5.) To compare the association of the clinical outcomes among patients given and not given antimicrobials, 6.) To compare the association of the immediate neonatal outcomes among pregnant patients given and not given antimicrobials.@*METHODS@#A retrospective cohort study was done covering a period of 1 year from January to December 2018. The study included all pregnant patients who were admitted and listed based from the master list of the Department of Obstetrics and Gynecology. Included are all the retrieval charts from the records sections whereas gynecologic and those cases with medical records not retrieved were excluded. A total of 3,495 obstetrics patients admitted from January to December 2018 were retrospectively studied. From this group, the complete medical records of 1,092 obstetrics patients were retrieved and included in this study. Detailed clinical information, antibiotics administered, diagnostic and other relevant investigations, and clinical outcomes were recorded from case sheets. After the data were collected from patients' medical records, datas were manually entered into an electronic spreadsheet file, and the data processing and analysis were then carried out using statistical software Stata 13.@*RESULTS@#There were 1,092 women included in the current study with more than half of them administered or received antibiotics as part of their regimen (n = 663, 60.71 %) compared to those not administered antibiotics (n = 429, 39.29%). The results showed that the prevalence of obstetric patients (undelivered, delivered, ectopic pregnancy and abortion) prescribed and given antibiotics was between 57.75 to 63.62 per cent. There was no association between the comparison groups in terms of age (x 2 : 3.62, p: 0.31 ), marital status (x2 : 1.29, p: 0.26), body mass index classification (x 2 : 6.88, p: 0.08), hemoglobin level (x 2 : 1.74, p: 0.19), and number of prenatal consults (x2 : 3.13, p: 0.21 . There was a significantly higher proportion of women who delivered abdominally that were administered antibiotics (x 2 : 32.45, p<0.01) as compared to women who delivered vaginally (spontaneous or assisted), admitted due to ectopic pregnancy, abortion, and medical management. Cephalosporins are the most widely used antibiotics. Cefazolin (60.48%) followed by Cefuroxime (39.97%) were commonly used for pre-operative prophylaxis and urinary tract infection. Other commonly used antibiotics are Clindamycin (3.62%), Ampicillin (3.47%), Amikacin (2.56%), Ceftriaxone (2.11 %) and Doxycycline (1 .81 %). In 803 of cases (74.15%), reason for administration was not recorded in the chart and stated on working impression and final diagnosis. Majority of the antibiotics were empirically given (99.10%). The irrational use of antibiotics among those administered was observed in 564 cases (52.47%) (95% Cl: 49.46-55.47%). Rational use was only observed in 99 cases (19.08%). Among those not given antibiotics, 420 cases (80.92%) with adherence to antibiotic guidelines and 9 cases (52.47%) inappropriately not given antibiotics. It can also be noticed that there was an association between administration (and nonadministration) of antibiotics - and having an appropriate indication for such action (x2: 718.97, p<0.01 ). Maternal and neonatal outcomes showed that there was no noted association between the administration of antibiotics, and selected outcomes. Additional morbidity appeared to be slightly increased among those who were not given antibiotics than otherwise (z: -1.90, p: 0.60).@*CONCLUSION@#The study demonstrated that most of the antibiotic administration from January 1 to December 31, 2018

Examples of Clinical Application of "The Time of Six Meridians Diseases Tending to be Cured" / 中国中医药信息杂志

It has always been controversial about the theory of "the time of six meridians diseases tending to be cured" in Shang Han Lun. Many doctors pay more attention to the time of disease remission, while neglecting its appearance, aggravation and the meaning of treatment according to the rule of time. Based on the theory of "the time of six meridians diseases tending to be cured", this article made diagnosis and treatment of three clinical medical records about cough, mouth-dry and bitterness, and flushing from the time of Shaoyang, Taiyang, and Yangming meridians tending to be cured, and analyzed the clinical syndrome differentiation and characteristics of the theory of"the time of six meridians diseases tending to be cured".

A capacidade de estar só na presença do casal / La capacidad de estar solo en presencia de la pareja / The capacity to be alone in the couple's presence / La capacité d'être seul en présence du couple

Ao se interrogar sobre o dispositivo das consultas familiares psicanalíticas e das consultas familiares por ocasião dos pedidos de atendimento para os filhos, o autor propõe que se considere que a problemática da capacidade de estar só na presença do casal é o organizador privilegiado dessa situação. Isso o leva a retomar a função do objeto-casal e de sua representação interna na organização pulsional da sexualidade infantil como uma saída para os impasses e paradoxos da crise edipiana. Assim, a fantasia da cena primária encontra uma de suas correspondências no quotidiano da vida familiar. Por fim, o autor situa a capacidade de estar só na presença do casal no interior de uma série de experiências intermediárias nas quais se pode pôr em ação a distinção percepção/representação, tão essencial ao funcionamento psíquico.

When wondering about psychoanalytic consultations with families, particularly about family consultations which involve requests for psychoanalytic treatment for children, the author suggests that the issue of the capacity to be alone in the couple's presence should be considered the privileged organizer of this situation. This thought leads the author to rethink the function of couple as object and its internal representation in the drive-oriented organization of infantile sexuality as a way of dealing with the impasses and paradoxes of Oedipal crisis. The fantasy of primal scene, therefore, finds one of its equivalents in the everyday family life. Finally, the author places the capacity to be alone in the couple's presence among a series of intermediary experiences in which the difference between perception and representation may be implemented. And, making this difference, the author continues, is vital to the psychic functioning.

En s'interrogeant sur le dispositif des consultations familiales psychanalytiques et des consultations familiales à l'occasion des demandes de soins pour les enfants, l'auteur propose de considérer que la problématique de la capacité d'être seul face au couple en est l'organisateur privilégié. Ceci l'amène à reprendre la fonction de l'objet-couple et de sa représentation interne dans l'organisation pulsionnelle de la sexualité infantile comme issue aux impasses et paradoxes de la crise oedipienne. Le fantasme de la scène primitive trouve ainsi l'une de ses correspondances dans le quotidien de la vie familiale. Enfin, l'auteur situe la capacité d'être seul en présence du couple au sein d'une série d'expériences intermédiaires dans lesquelles peut se mettre au travail la différenciation perception/représentation tellement essentielle au fonctionnement psychique.

Interrogándose sobre el dispositivo de las consultas familiares psicoanalíticas y de las consultas familiares en función de pedidos de tratamiento para niños, el autor plantea considerar la problemática de la capacidad de estar solo en presencia de la pareja como organizador privilegiado de esta situación. Esto lo lleva a retomar la función del objeto pareja y su representación interna en la organización pulsional de la sexualidad infantil como salida de impases y paradojas de la crisis edípica. La fantasía de la escena primitiva halla así uno de sus enlaces en la cotidianidad de la vida familiar. Finalmente, el autor ubica la capacidad de estar solo en presencia de la pareja en el centro de un conjunto de experiencias intermedias dentro de las cuales puede activarse la diferenciación percepción/representación, tan esencial para el funcionamiento psíquico.

Finales de análisis en niños. fin de análisis de Lucas / End of child analysis. end of the analysis of Lucas

Paula, la terapeuta, nos presenta un niño, llamado Lucas, cuyo tratamiento comenzó a sus dos años y medio porque no tenía lenguaje. No se trataba de una historia a develar sino de una historia a construir. Es así como la intervención de la analista fue posibilitando otros sentidos al devenir mortífero, construyendo y posibilitando que Lucas empezara a hablar, asistir con regularidad al jardín y a disminuir sus enfermedades.Luego de cuatro años de tratamiento comienzan las resistencias, Lucas no quiere venir solo a sus sesiones. El niño ahora hablaba, se enojaba, exigía, no se conformaba. Ya tenía voz, su retracción había quedado atrás. Se hizo indispensable la inclusión de entrevistas familiares.Fue en esos momentos que la terapeuta comienza a pensar en un posible fin de análisis o quizás que se había cumplido una etapa en este tratamiento. En la última entrevista familiar que nos presenta la terapeuta está la clave de por qué es el momento de dejar ir al niño. Ha sido un niño retenido en su desarrollo, quizás no permitírselo hubiese sido repetir aquello retentivo familiar. ¿Será que el fin del análisis con el niño abrió un nuevo espacio para los padres?.

Paula, the therapist, presents us a boy called Lucas, whose treatment beganwhen he was two and a half years old since he lacked language skills. Thisstory was not meant to be revealed but to be unfolded. Therefore, the therapist’sintervention began to allow other senses to the deadly evolution by movingforward and making it possible for Lucas to start talking, attending kindergartenon a regular basis and reducing the amount of illnesses he might have.Lucas starts to resist after undergoing treatment for four years; he refusesto attend sessions alone. By this time he talked, annoyed himself, made demands and was dissatisfied. He already had a voice and his shyness hadbeen left behind. The inclusion of family interviews became essential.By this time the therapist started to consider the possibility of putting an endto the analysis or that a stage in the treatment had already been reached.The therapist presents us the last family interview, which includes the keythat indicates the reason why the child should be released. He has beenrestrained in his development. Were he not released, his family’s withholdingwould be repeated. Is it possible that the end of the child’s analysis led to anew space for his parents?.

Paula, la thérapeute, nous présente un enfant, Lucas. Son traitement acommencé quand il avait deux ans et demi parce qu’il n’avait pas de langage.Ce ne fut pas une histoire à dévêler, mais une histoire à construire.Ainsi, l’intervention de l’analyste a permis de développer d’autres sensdifférents au devenir mortel, permettant de construire et possibiliter Lucasde commencer à parler, à assister régulièrement au jardin d’enfants, et àdiminuer ses maladies.Après quatre ans de traitement, les résistances commencent. Lucas ne veutpas rester seul dans ses sessions. Maintenant, l’enfant parle, se met en colère,exige, n’est pas satisfait.Il a une voix. Sa rétraction a été laissée en arrière. L’inclusion des entretiensfamiliales est devenu indispensable.C’est à ce moment-là que la thérapeute commence à penser à la finalisationde l’analyse, ou à la possibilité d’avoir accompli une étape dans ce traitement.Dans le dernier entretien familial présenté par la thérapeute, on peut trouverla clé depourquoi il est temps de laisser partir l’enfant. Il est un enfant qui aété retenu dans son développement. Peut-être ne pas lui permettre de partir,ce serait une répétition d’aspects retenus de la famille. Est-ce que la fin del’analyse avec l’enfant ouvre un nouvel espace pour les parents?.