Reinserções, inserções e deserções: cartografia do dispositivo "reinserção social" para adolescentes com histórico do uso abusivo de álcool e outras drogas / Reinsertions, insertions and desertions cartography of the device "social reintegration" for adolescents with a history of abusive use of alcohol and other drugs

Esta tese-pão é escrita sob a metodologia da cartografia, com cascas de discussão teórica e miolo de narrativas em campo e dessa forma, deixa convergir e transpassar impressões, afetos e vivências sobre a ideia da reinserção social alçada à categoria de dispositivo (tal qual ocorre com o dispositivo das drogas na atualidade), à luz de autores que permitem pensar as questões de saúde coletiva pelo prisma das política de subjetivação, e à luz de uma vivência na pele enquanto trabalhador. Persegue algumas de suas possíveis linhas traçadas pelas políticas públicas vigentes, pelas diferentes adolescências nas diferentes classes sociais, com suas diferentes inserções sociais, pela disputa biopolítica que causa segregações transeuntes, privilégios de circulações ou operações urbanas de triagem de estratos sociais por conta de suas características de poderio econômico e cor-de-pele. Passa pelos diagramas da droga enquanto dispositivo e pela função da Guerra às Drogas na cristalização dessas formas de vida. Presta certo tributo à literatura menor e às narrativas de si, enquanto uma trincheira na disputa por territórioslinguagens. Todo território é psíquico

This bread-thesis is written under the methodology of cartography, with theoretical discussions and the core of narratives in the field, and thus, it allows us to converge and transgress impressions, affections and experiences on the idea of social reinsertion, elevated to the category of device (as such occurs with the device of drugs in the present time), in the light of authors that allow to think about collective health issues through the prism of the politics of subjectivation, and in the light of an experience in the skin as a worker. It pursues some of its possible lines drawn by the current Public Policies, by the different teens in the different social classes, with their different social insertions, by the biopolitical dispute that causes passerby segregations, privileges of circulations or urban operations of sorting of social strata by its characteristics of economic power and color of skin. It goes through the diagrams of the drug as a device and the function of the War on Drugs in the crystallization of these forms of life. It pays a certain tribute to the minor literature and to the narratives of itself, as a trench in the dispute for territories-languages. All territory is psychic

IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

Estándares de Acreditación "derechos de pacientes": revisión y estado actual en Centros de Tratamiento en Drogadicción en Colombia / Accreditation standards concerning patients' rights: a review of the current state of affairs related to drug-addiction treatment centers in Colombia

Objetivos Caracterizar y referenciar estado actual del grupo estándares de acreditación "derechos de los pacientes" en muestra de instituciones de tratamiento en drogas de Colombia. Métodos Estudio de enfoque mixto, empírico de tipo descriptivo y hermenéutico; muestra piloto de 21 centros de tratamiento en drogas en las cuales se determina estado actual de los estándares de acreditación "derechos de los pacientes"; se evalúa posible relación o independencia de las variables categóricas mediante prueba exacta de Fisher con nivel de significancia de 0,05. En fase paralela se realiza revisión documental de referenciación. Resultados: Los Centros de tratamiento en drogas suministran información en mayor proporción a familiares (95 %) que a los pacientes (90 %) y menores de edad (81 %). Representan posibles barreras de acceso al tratamiento, ser portador o enfermo VIH (29 %), orientación sexual LGTB (14 %) y ser mujer (10 %); religión y raza no son condiciones para discriminación o barreras de atención. Existen estándares coincidentes en el grupo "derechos de los pacientes" en el sistema de acreditación Colombiano con The Joint Commission, pero esta última entidad acreditadora tiene desarrollos importantes en un manual específico aplicable a instituciones de tratamiento de adicción a drogas. Conclusiones Los centros evaluados en Colombia, muestran logros en el grupo de estándares para la acreditación derechos de los pacientes, pero estos estándares requieren revisión para su adaptación a los desarrollos internacionales y a la particularidad de la población adicta y de las instituciones de tratamiento.

Objective Characterizing and contrasting the current state of affairs concerning patients' rights-associated accreditation standards in a sample of drug-addiction treatment centers in Colombia. Methods This was mixed methodology research (i.e. descriptive and hermeneutic); a pilot sample of 21 drug-addiction treatment centers in Colombia was used for determining the current state of patients' rights accreditation standards. The possible relationship or independence between categorical variables was evaluated by using Fisher's exact test (0.05 significance level). A contrasting documentary review was made at the same time. Results Drug-addiction treatment centers provided more information for families (95 %) than patients (90 %) or minors (81 %). Possible barriers to gaining access for treatment were being HIV positive (29 %), being part of the LGTB population (14 %) and being female (10 %); religion and ethnicity were not seen as grounds for discrimination or treatment barriers. The patients' rights standards group coincided with Colombia´s accreditation system and Joint Commission standards; however, the latter accreditation entity has made significant progress regarding a specific manual for drug-addiction treatment centers. Conclusions The centers assessed in Colombia had made advances regarding accrediting patients' rights, but such standards require revision for being adapted to international developments and specific matters involved in treating addicts and the specific conditions for institutions dealing with such treatment.

Normas mínimas de atención para centros que dan servicios a personas con problemas derivados del consumo de sustancias adictivas: acuerdo ministerial No. SP-M-1152-2006 / Minimum standards of care for centers that provide services to people with problems derived from the consumption of addictive substances: ministerial agreement No. SP-M-1152-2006

Enfocado a los establecimientos que vayan a cuidar de personas con problemas de adicción. En la primera parte describe una serie de normas, mientras que en la segunda, el acuerdo propiamente dicho. Esta normativa es el resultado de una propuesta de diferentes sectores que en el 2005 se unieron para su elaboración. La idea general es el mejoramiento de los servicios, más que utilizarla como una meta en sí misma. Dado el incremento de las personas en el consumo de drogas ilícitas y las diversas consecuencias personales, familiares, sociales y particularmente en el sistema de salud, hubo un incremento de instituciones para atender esta demanda, cada una con una propuesta y método distinto. Por todo ello se hacía necesario elaborar y proponer una normativa que normalizada la calidad de los servicios de cada una de estas instituciones; estas son tan solo las reglas mínimas para la atención al usuario, la calidad e incremento de estos estándares dependerá de cada institución. Incluye: normas generales, de oferta de servicios, de tratamiento, sobre el ingreso, egreso, referencia y seguimiento; sobre el derecho del usuario, aspectos físicos del centro, normas sobre el personal. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada centro, incluidos el equipo y recurso humano y técnico. Dentro del acuerdo, hay una descripción de las categorías que pueden tener los centros de rehabilitación.