As Relações Intersubjetivas e os espaços de Simbolização destinados às Equipes Profissionais que Implementam Políticas Públicas / Intersubjective Relations and Spaces of Symbolization Intended for Professional Teams that Implement Public Policies / Relaciones Intersujetivas y Espacios de Simbolización Destinados a Equipos Profesionales que Implementan Políticas Públicas

Considerando que um grupo é um agenciamento de vínculos intersubjetivos, que permite a expressão de relações entre vários sujeitos, o objetivo deste artigo é discutir a importância dos espaços de simbolização direcionados às equipes profissionais, no que se refere ao impacto destas ações na implementação de políticas públicas. Para esta discussão utilizar-se-á de uma experiência de campo profissional objeto de discussão no processo de doutorado. Participou do campo um grupo de educadores de oficinas culturais e artísticas (oficineiros de cultura) em uma intervenção de Grupo Operativo. Essa equipe profissional (participantes do campo) era composta por doze servidores públicos da Secretaria Municipal de Cultura (SMC) de uma cidade no interior de São Paulo. A duração da intervenção de Grupo Operativo foi de um ano. O trabalho permitiu compreender a importância de espaços que permitam trabalhar/simbolizar as experiências das equipes, no trabalho realizado durante a implementação das políticas: as experiências podem ser elaboradas e reconstruídas, a partir do que é depositado sobre a equipe, seja pela instituição na qual trabalham ou pelos usuários.

Whereas a group is an agency of intersubjective links, which allows the expression of relationships between several subjects, the aim of this article is to discuss the importance of symbolization spaces directed at professional teams, regarding the impact of these actions on the implementation of public policies. For this discussion, field experience will be used the professional subject of discussion in the doctoral process. A group of educators of cultural and artistic workshops (culture "coordinators" named in Brazil "culture oficineiros") in an Operative Group intervention. This professional team (field participants) was composed of twelve public servers of the Municipal Secretariat of Culture (SMC) of a city in the interior of São Paulo. The duration of the Operative Group intervention was one year. The work made it possible to understand the importance of spaces that allow working/symbolizing the experiences of the teams, in the work implementation of policies: experiences can be developed and developed by the reconstructed, from what is deposited on the team, either by the institution in which they work or by users.

Considerando que un grupo es una agencia de vínculos intersubjetivos, que permite la expresión de relaciones entre varios temas, el objetivo de este artículo es discutir la importancia de simbolización dirigida a los equipos profesionales, sobre el impacto de estas acciones en la implementación de políticas públicas. Para esta discusión, se utilizará una experiencia de campo, tema profesional de discusión en el proceso de doctorado. Un grupo de educadores de talleres culturales y artísticos (coordinadores de cultura llamados "oficineiros de cultura" en Brasil) en una intervención de Grupo Operativo. Este equipo profesional (participantes de campo) estaba compuesto por doce servidores autoridades de la Secretaría Municipal de Cultura (SMC) de una ciudad del interior de São Paulo. La duración de la intervención del Grupo Operativo fue de un año. El trabajo permitió comprender la importancia de los espacios que permiten trabajar/simbolizar las experiencias de los equipos, en el trabajo de implementación de políticas: las experiencias pueden ser elaborados y reconstruidos, a partir de lo depositado en el equipo, ya sea por la institución en la que trabajan o por los usuarios.

Effects of hierarchical management based on medical alliances on patency of arteriovenous graft in hemodialysis patients / 中华肾脏病杂志

Objective:To investigate the impacts of hierarchical management based on medical alliance on the patency of arteriovenous graft (AVG),and provide a basis for further exploration of optimal AVG management.Methods:In this retrospective cohort study, clinical and follow-up data of patients with AVG established in the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2021 were analyzed. Patients were divided into medical alliance group and non-medical alliance group according to whether they were under hierarchical management model, and the patency rate of AVGs and the incidence of clinical events were compared between the two groups.Results:A total of 328 AVGs were included in this study, which were from 151 hemodialysis centers, including 189 AVGs (57.6%) from 72 centers in medical alliance group, and 139 AVGs (42.4%) from 79 centers in non-medical alliance group. The age of the patients was (55.57±11.80) years, among whom 130 (39.6%) were males and 126 (38.4%) were diabetic. The follow-up time of AVGs in this cohort was 15.5 (9.5, 26.2) months, with 15.4 (9.8, 25.2) months in medical alliance group and 15.5 (9.2, 27.3) months in non-medical alliance group. The incidence of thrombosis or occlusion (0.328 times/patient-year), graft dissection (0.007 times/patient-year), graft infection (0.030 times/patient-year), and catheter utilization (0.043 times/patient-year) in the medical alliance group were lower than those in the non-medical alliance group (0.589 times/patient-year, 0.040 times/patient-year, 0.054 times/patient-year and 0.147 times/patient-year, respectively), and there was no significant difference in clinic follow-up rates between the two group (1.91 times/patient-year vs. 1.94 times/patient-year). The median primary patency time was 17.4 (95% CI 11.3-23.5) months, the median primary assisted patency time was 32.6 (95% CI 25.0-40.2) months, and the median secondary patency time was 47.9 (95% CI 40.0-55.8) months in the medical alliance group, compared with 12.3 (95% CI 9.4-15.2) months, 19.4 (95% CI 14.3-24.5) months, and 34.6 (95% CI 29.3-39.9) months in the non-medical alliance group, respectively. Primary patency were significantly higher in the medical alliance group (77.4%, 62.2%, 39.9%, and 26.6%) than those in the non-medical alliance group (71.1%, 50.1%, 30.6%, and 13.4%) at 6, 12, 24, and 36 months (Log-rank test, χ2=4.504, P=0.034). Primary assisted patency were significantly higher in the medical alliance group (90.9%, 84.3%, 67.1%, and 46.1%) than those in the non-medical alliance group (89.2%, 75.7%, 42.0%, and 16.6%) at 6, 12, 24, and 36 months (Log-rank test, χ2=10.655, P=0.001). Secondary patency were significantly higher in the medical alliance group (96.8%, 91.8%, 84.2%, and 74.0%) than those in the non-medical alliance group (89.9%, 85.8%, 69.3%, and 47.5%) at 6, 12, 24, and 36 months (Log-rank test, χ2=11.634, P=0.001). Multivariate Cox regression analysis showed that it was a protective factor for primary patency ( HR=0.708, 95% CI 0.512-0.980, P=0.037), primary assisted patency ( HR=0.506, 95% CI 0.342-0.749, P=0.001) and secondary patency ( HR=0.432, 95% CI 0.261-0.716, P=0.001) under the medical alliance model. Conclusion:The hierarchical management based on medical alliances can improve the patency of AVGs and reduce the incidence of clinical events.

Relational capability: a study of the Brazilian Agricultural Research Corporation / Capacidad relacional: un estudio de la Empresa Brasileña de Investigación Agrícola / Capacidade relacional: um estudo da Empresa Brasileira de Pesquisa Agropecuária

Abstract The Brazilian Agricultural Research Corporation (EMBRAPA) plays an important role in Research and Development (R&D) for generating innovations. Most innovations are generated through R&D alliances with external partners, stimulating relational capability (RC), that is, a construct of strategic management of alliances with propositions for procedures that have not yet been empirically verified. In this context, we investigated how relational capability processes contribute to generating innovations. We conducted qualitative research using a case study based on interviews, document analysis, and observation. Three strategic R&D alliances involving EMBRAPA and external partners constituted the analysis corpus. The main contribution to knowledge advancement is a multidimensional fraProgmework for generating innovations from strategic R&D alliances, based on the empirical evidence of processes of EMBRAPA relational capability and its external partners. This new framework sheds light on how a public research enterprise absorbs knowledge and uncovers the processes of institutionalization and relational capability spillover.

Resumen La EMBRAPA desempeña un papel importante en Investigación y Desarrollo (I+D) para generar innovaciones. La mayoría de las innovaciones se genera a través de alianzas de I+D con socios externos, estimulando la capacidad relacional (CR), es decir, un constructo de gestión estratégica de alianzas con propuestas de procedimientos que aún no se han verificado empíricamente. En este contexto, investigamos cómo los procesos de CR contribuyen a generar innovaciones. Para ello, realizamos una investigación cualitativa utilizando un estudio de caso basado en entrevistas, análisis de documentos y observación. Tres alianzas estratégicas de I+D en las que participaron EMBRAPA y socios externos constituyeron el corpus de análisis. La principal contribución al avance del conocimiento es un framework multidimensional para generar innovaciones a partir de alianzas estratégicas de I+D, con base en la evidencia empírica de los procesos de CR de EMBRAPA y sus socios externos. Este nuevo framework arroja luz sobre cómo una empresa pública de investigación absorbe el conocimiento y descubre los procesos de institucionalización y repercusión de la CR.

Resumo A EMBRAPA desempenha papel importante em P&D na geração de inovações. A maioria das inovações é gerada por meio de alianças de P&D com parceiros externos, estimulando a capacidade relacional (CR), ou seja, um construto de gerenciamento estratégico de alianças com proposições de procedimentos que ainda não foram empiricamente verificados. Nesse contexto, investigamos como os processos de capacidade relacional contribuem para gerar inovações. Para tanto, realizamos pesquisa qualitativa utilizando um estudo de caso, baseado em entrevistas, análise de documentos e observação. Três alianças estratégicas de P&D envolvendo a EMBRAPA e parceiros externos foram analisados. A principal contribuição para o avanço do conhecimento é um framework multidimensional para gerar inovações a partir de alianças estratégicas de P&D, com base na evidência empírica dos processos da CR da EMBRAPA e de seus parceiros externos. Este novo framework lança luz sobre como uma empresa pública de pesquisa absorve conhecimento e descobre os processos de institucionalização e repercussão da CR.

Contributions of René Kaës to the epistemology of psychoanalysis / Contribuições de rené kaës para a epistemologia da psicanálise

RESUMO: O objetivo deste artigo é discutir os efeitos das alianças inconscientes na restrição à extensão da psicanálise no que se refere à construção do conhecimento psicanalítico sobre os grupos. Cinquenta e cinco textos publicados na Revista Brasileira de Psicanálise RBP, entre 1967 e 1976, foram analisados a partir do referencial teórico-metodológico proposto por René Kaës. Numa breve reconstrução histórica, operou-se com o conceito de alianças inconscientes com o propósito de investigar as bases narcísicas presentes desde as origens da psicanálise; que restringiram a capacidade de pensar o grupo no campo da psicanálise. Benefícios narcísicos foram extraídos destas resistências que ainda hoje dificultam a extensão da psicanálise no que diz respeito à inclusão do grupo como objeto teórico.

Abstract: Contributions of René Kaës to the epistemology of psychoanalysis. The objective of this article is to discuss the effects of the unconscious alliances on extension of psychoanalysis. 55 texts published in the Revista Brasileira de Psicanálise between 1967 and 1976 were analyzed under the theoretical framework of René Kaës. A brief historical reconstruction with the concept of unconscious alliances in order to investigate the narcissistic bases present since the origins of psychoanalysis; that restricted the capacity to think in the group in the field of psychoanalysis. Narcissistic benefits were extracted of this resistance, that still today difficult the extension of the psychoanalysis for the inclusion of the group as a theoretical object.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Case study of different types of telemedicine diagnostic projects / 中华医院管理杂志

Objective@#To compare the similarities and differences of four telemedicine diagnostic projects, for providing evidence-based policy-making advice for the development of telemedicine diagnostic projects in China.@*Methods@#Four projects led by the government, close medical alliances, loose medical alliances and companies were selected from November 2018 to June 2019. Through semi-structured interviews with different leaders, the authors analyzed the characteristics, problems and difficulties of different projects from three dimensions of organizational system, working conditions and operational effects.@*Results@#A total of 18 people were interviewed. Projects were different from each other in leaders, connection mechanism and effectiveness, participants and timeliness as well. The projects led by the government and close medical alliances had limited local participants with strong connection, clear but limited sources of diagnostic doctors and relatively large workload. While the projects led by loose medical alliances and companies had a wide range of participants, relatively weak connection efficiency and long response time.@*Conclusions@#Different types of telemedicine diagnostic projects have supplemented the manpower shortage of diagnosis physicians at primary medical institutions, introduced new service participants, as well as improved the medical service system.

A transmissão psíquica do medo e sua rematrização pelo método ativo / Psychic transmission of fear and its rematrix by the active method / La transmisión psíquica del miedo y su rematrización por el método activo

Este artigo propõe uma reflexão sobre a transmissão psíquica de pais para filhos e a produção de sintomas e fantasias na criança. Para tanto, realizou-se uma análise sobre as alianças inconscientes estabelecidas no grupo familiar, nas quais a vergonha e os segredos são as bases primárias para a formação das patologias de transmissão do medo. Por meio de sessões de orientação a pais, adentrou-se aos espaços intrapsíquicos para facilitar a rematrização de histórias fantasísticas da criança e a desarticulação de seus sintomas. Assim demonstrou-se pelo Método Ativo, o qual integra a Psicanálise e o Psicodrama, por meio de objetos intermediários, para obter-se resultados em um caso que retrata a família como um sistema aberto em que o medo se instala em pacientes identificados.

This article proposes a reflection on parents’ psychic transmission to children and symptom and fantasy production in children. To this end, an analysis was made of the unconscious alliances established in a family group, in which shame and secrets are the primary basis for the formation of the pathologies of fear transmission. Through sessions of parenting orientation, it was introduced to the intra-psychic spaces to facilitate the rematrix of fantastical stories of the children and the disarticulation of their symptoms. Therefore, it was demonstrated by the Active Method, which integrates Psychoanalysis and Psychodrama, through intermediary objects, to obtains results in a case that portrays the family as an open system in which fear installs itself in identified patients.

Este artículo propone una reflexión sobre la transmisión psíquica de padres a hijos y la producción de síntomas y fantasías en el niño. Para tanto, se realizó un análisis sobre las alianzas inconscientes establecidas en el grupo familiar, en las cuales la vergüenza y los secretos son las bases primarias para la formación de las patologías de transmisión del miedo. Por medio de una orientación de padres, se adentró a los espacios intrapsíquicos para facilitar la rematrización de historias fantasísticas del niño y la desarticulación de sus síntomas. Así, se demostró por el Método Activo, el cual integra el Psicoanálisis y el Psicodrama, por medio de objetos intermediarios, para obtener resultados en un caso que retrata a la familia como un sistema abierto en que el miedo se instala en pacientes identificados.

A formação do casal conjugal: um enfoque psicanalítico / The formation of married couple: a psychoanalytic approach

O presente estudo tem como objetivo investigar o modo como o casal se constitui, com base no enfoque psicanalítico, levando em consideração os aspectos intrapsíquicos e intersubjetivos examinam-se, inicialmente, a escolha amorosa como base do processo identificatório e suas implicações na formação do casal. Em seguida, investigam-se o conceito de vínculo e a formação conjugal, a partir das concepções de Puget, Berenstein, Eiguer e Kaës. Por fim, discute-se o conceito de alianças inconscientes, a partir de suas tipologias. Constata-se que a formação do casal oferece, por um lado, um continente, palco de encenações de acordos e pactos inconscientes, por outro, possui mecanismos defensivos para lidar com a vida coletiva. Conclui-se que o casal tende a uma estabilidade quando os modelos de referência são recriados, formando uma estrutura inédita de relação, e quando se adequam ao macro contexto sociocultural.

The purpose of this study is to investigate the formation of the married couple through a psychoanalytical approach, taking into consideration its intrapsychic and intersubjective aspects. The authors start by examining the love choice as the foundation of the identification process and its implications in the formation of the couple. Next, they investigate the concept of bond and the conjugal formation from the standpoints of Puget, Bernstein, Eiguer and Käes. Finally, the authors discuss the concept of unconscious ties through its typologies. The study observes that the formation of the couple offers, on one hand, a continent for the staging of agreements and unconscious pacts, and on the other, defensive mechanisms to deal with collective life. The study concludes that the couple tends towards stability when the circumstances recreate reference models - forming an unprecedented relationship structure - and when such models fit into the broader sociocultural context.

Comunicar para el desarrollo: una propuesta de divulgación radiofónica en la lucha contra el hambre y la malnutrición en Nicaragua / Communicating for development: a proposal for radio broadcasting to deal with hunger and malnutrition in Nicaragua

Nicaragua presenta altos niveles de inseguridad alimentaria y nutricional. Predomina la deficiencia proteico-energética y la carencia de nutrientes específicos y al mismo tiempo presenta la superposición epidemiológica-nutricional y la doble carga de riesgos para la salud. Faltan conocimientos para optimizar los escasos recursos para adquirir productos de mayor valor nutricional. El objetivo fue contribuir a reducir el hambre y la desnutrición y mejorar la alimentación y el estado nutricional de la población del municipio nicaragüense de Somotillo, a través de estrategias educativas difundidas por el medio radiofónico. Se ejecutó el programa "Por una mejor nutrición" en la radio (1 junio al 29 de julio, 2016) y se abordaron cuatro temas: conocimientos sobre alimentación saludable, higiene alimentaria, enfermedades asociadas a la malnutrición y alimentación del escolar y se acompañaron de tres cápsulas informativas cada uno, transmitidas 1v/s y 5v/s (8v/día), respectivamente, más una sesión 1v/s de respuesta a los oyentes (maestros y niños escolares). Además, se hizo una evaluación cualitativa (grupo de discusión con maestros y promotores de salud) y se aplicó un cuestionario de 5 preguntas pre y post intervención a 600 escolares seleccionados al azar en 20 escuelas rurales. Se encontró dominio parcial del tema de higiene pre-intervención y fallas en las acciones para prevenir las enfermedades que afectan el estado nutricional de los escolares (post intervención). El programa benefició a 2.349 estudiantes y familias. Esta experiencia puede mejorar el empoderamiento de las familias y la comunidad frente a los problemas de alimentación y prácticas higiénicas peligrosas existentes, pero requieren por parte de las comunidades garantizar la sostenibilidad y replicabilidad del mismo(AU)

Nicaragua has high levels of food and nutritional insecurity. Protein-energy deficiency and lack of specific nutrients predominate, while epidemiological-nutritional deficiencies and excess overlap and the double burden of health risks. There is a lack of knowledge in order to optimize scarce resources and to acquire products of greater nutritional value. The aim was to contribute to the reduction of hunger and malnutrition and to improve the diet and nutritional status of the population of the Nicaraguan municipality of Somotillo, through educational strategies broadcasted by radio. The program "For better nutrition" was carried out on the radio (1 June to 29 July 2016) and addressed four topics: knowledge of healthy eating, food hygiene, diseases associated with malnutrition and school feeding, and was accompanied by three information capsules, each transmitted 1/s and 5/s (8v/day), respectively, plus a 1/s response session for listeners (teachers and school children). In addition, a qualitative evaluation (discussion group with teachers and health promoters) and a questionnaire of 5 pre and post intervention questions were applied to 600 randomly selected schoolchildren in 20 rural schools. Partial mastery was found of the issue of pre-intervention hygiene and failures in actions to prevent diseases that affect the nutritional status of schoolchildren (post-intervention). The program benefited 2,349 students and families. This experience can improve the empowerment of families and the community in the face of existing food problems and dangerous hygiene practices(AU)

Extended care for chronic wound ostomy by specialist nurses in a medical alliance / 中华医院管理杂志

Development of medical alliances can provide patients of wound ostomy with cost-effective, safe and effective continuing specialized care at their community, gradually homogenizing hospital-community specialized care. By means of establishing a nurse advice referral and specialist nurses consultation mechanism, Shenzhen Luohu Hospital Group has achieved to share specialist nursing resources between hospitals and social health centers.This practice can reduce re-hospitalization rate of these patients, reduced their economic burden, save medical resources and improve patient satisfaction as well.

Practice and exploration of a new model of extended nursing care based on regional informationization platform within a medical alliance / 中华医院管理杂志

The rapidly aging society gives rise to sizable demands for chronic disease nursing care. With IT development as backup, the hospital has developed a platform for regional collaborative nursing informationization within a medical alliance and a health management platform for home care of the elderlies. This practice can build an extended nursing care model, featuring the three main service lines of " hospital-family, hospital-medical alliance and hospital-community hospital-family". The model provides diversified, personalized, disease specific, informationization and multi-disciplinary coverage for nursing care, providing the primary level with high quality nursing resources.Medical alliances and corresponding communities share information, for a full-range, full region and full timeframe coverage of nursing health supervision and scientific guidance, thus effectively minimizing the rate of revisit to upper-level hospitals by patients and implementing the hierarchical medical system.

Herramientas estratégicas para la propuesta de modelo de cadena productiva forestal para Arauca, Colombia / Strategic tools to formulate a proposal for a forest productive chain model for Arauca, Colombia / Ferramentas estratégicas para o modelo de cadeia produtiva florestal proposta para Arauca, Colômbia

Resumen En el presente artículo se realizó un análisis diagnóstico con miras a identificar acciones para favorecer la consolidación de una cadena productiva forestal en Arauca, Colombia, como estrategia de desarrollo. A partir de una investigación de tipo cualitativo, con consulta a expertos y con una metodología de planeación participativa, se desarrolló un análisis de debilidades, fortalezas, oportunidades y amenazas (DOFA). También se identificaron elementos que dieron soporte para un posterior análisis Mactor® (Matriz de alianzas y conflictos, tácticas, objetivos y recomendaciones) para identificar intereses de los actores de la cadena, y finalmente se propuso un modelo de representación de la cadena productiva forestal del departamento, con sus respectivos eslabones y agentes.

Abstract In the present article, a diagnostic analysis aimed at identifying actions to favor the consolidation of a forest productive chain in Arauca, Colombia, as a development strategy, was carried out. From a qualitative investigation, with consultation to experts and with a methodology of participative planning, an analysis of weaknesses, strengths, opportunities and threats was developed (SWOT). Elements also were identified, to gave support for a subsequent Mactor® analysis (Matrix of alliances and conflicts, tactics, objectives and recommendations) in order to identify interests of the actors in the chain, and finally was proposed a model of representation of the forest productive chain of the department, with its respective links and agents.

Resumo No presente artigo, foi realizada uma análise diagnóstica que objetivou identificar ações para favorecer a consolidação de uma cadeia produtiva florestal em Arauca, Colômbia, como estratégia de desenvolvimento. A partir de uma investigação do tipo qualitativa, com consulta a especialistas e com uma metodologia de planejamento participativo, foi desenvolvida uma análise de Forças, Fraquezas, Oportunidades e Ameaças (SWOT). Elementos que deram suporte para uma análise Mactor® subsequente (Matriz de alianças e conflitos, táticas, objetivos e recomendações) para identificar os interesses dos atores da cadeia também foram identificados e, finalmente, um modelo de representação da cadeia de produção florestal da departamento, com seus respectivos links e agentes.

En banda ancha: transmisión generacional y entre contemporáneos / In broadband. Generational transmission and among contemporary

Según los desarrollos de René Kaës la transmisión psíquica entre generaciones y contemporáneos se habrá de producir mediante el trabajo de la intersubjetividad. Este trabajo se apoya en los conceptos de crisis, apuntalamiento y alianzas inconcientes.

According to the developments of René Kaës the psychic transmission between generations and contemporaries is going to be produce through the work of intersubjectivity. This work is supported by the concepts of crisis, underpinning and unconscious alliances.

Selon les développements de René Kaës la transmission psychique entre générations et contemporains devra être produit par le travail de la intersubjectivité. Ce travail s´appui sur le concepts de crise, étayement et alliances inconcients.

Exploration into the medical model of medical alliances specialized in chronic wounds / 中华医院管理杂志

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system.

Continuity of medical care:a strategy to realize hierarchical medical system within the county / 中华医院管理杂志

This study analyzed the key links and main challenges in the implementation of hierarchical medical system within the county, namely such aspects as medical services, medical insurance, information and management. We took the continuity of medical care in countywide medical community as an entry point, in order to expound the concept and application of continuous service. This program covers continuous clinical pathway guiding and normalizing the inter-agency services between county and township level medical staff;the integrated payment strengthening the motivation of collaboration; the interconnected information promoting timeliness and effectiveness of technical and non-technical information transfer; and the three-dimensional and bi-directional management mode of the supporting and operating mechanisms. Local governments can propel the program gradually according to the actual situation, change the ideas and habits of each parties, and eventually achieve a long-term, and complex systematic hierarchical medical system.

European Reference Networks and its inspiration for China′s healthcare alliances / 中华医院管理杂志

Introduced in the paper is the profile of the European Reference Networks(ERNs) which were established to cope with rare diseases, complicated diseases, low incidence diseases and those of high costs. ERNs are valuable for the healthcare alliances to be built in China, in terms of objectives, tasks and mechanisms. It also presents policy references for improvement of the health service system, rational allocation of medical resources and better medical competence in China.

Research on the functional orientation of county-wide healthcare alliances in grounded theory / 中华医院管理杂志

Objective To explore the basic functional orientation of countywide healthcare alliances and how to maintain their stable operation and sustainable development direction. Methods 42 government officials, experts, employees of countywide healthcare alliances and residents were interviewed. The grounded theory was used to analyze data from the interview, with the core categories gradually extracted. Results Three basic functions were defined for such healthcare alliances, namely basic functions, stable operation and sustainable development. Conclusions The healthcare alliances prove an effective way to build the hierarchical medical system and improve people's health in general. Such alliances rely on good governance mechanism, reasonable balance mechanism of interests and scientific resource sharing mechanism.

A "loucura" ordinária das instituições / The ordinary « craziness ¼ of institutions / La «locura¼ ordinaria de instituciones

Com base numa intervenção em uma sociedade de psicanálise em crise, este artigo discute uma série de fenômenos psicossociais que contribuem para o desenvolvimento da « loucura ¼ ordinária de instituições. Aqui são evidenciados: os processos psíquicos inconscientes e preconscientes de ressonância, de colusão grupal e de alianças defensivas, que se articulam com processos organizacionais tóxicos ou, por vezes, têm neles a sua origem. No interior desses processos, a natureza e a estrutura do trabalho têm um papel central. Discute-se também uma abordagem transicional da intervenção, capaz de ajudar a superar diversos obstáculos à vitalidade individual e coletiva

Through a consultation to a psychoanalytic society in crisis, the article presents a series of phenomena which contribute to the ordinary « craziness ¼ of institutions. Are enlightened here: psychic unconscious and preconscious processes of resonance, group collusion, defensive alliances that are linked to (or sometimes are at the source of ) organisational ones among which the nature and structure of work play a central part ; a specific « transitional ¼ approach of intervention likely to help overcome numerous obstacles to individual and collective vitality

Con base en una intervención en una sociedad de psicoanálisis en crisis, este artículo discute una serie de fenómenos psicosociales que contribuyen al desarrollo de la «locura¼ ordinaria de instituciones. Aquí se evidencian: los procesos psíquicos inconscientes y preconscientes de resonancia, de colusión grupal y de alianzas defensivas, que se articulan con procesos organizacionales tóxicos o, a veces, tienen en ellos su origen. En el interior de estos procesos, la naturaleza y la estructura del trabajo desempeñan un papel central. Se discute también un enfoque transicional de la intervención, capaz de ayudar a superar diversos obstáculos a la vitalidad individual y colectiva

Research progress in targeted immunotherapy combined with ra-diotherapy for stageⅢ/Ⅳmelanomas / 中国肿瘤临床

Melanoma is the most aggressive and lethal malignant tumor in skin cancers. Operation resection is used to treat stageⅠ/Ⅱmelanomas, but traditional operation, chemotherapy, and radiotherapy inflicts adverse effects on late-stage melanomas. StageⅢ/Ⅳmelanomas are some of the most ineffectively treated tumors with poor prognosis. As a cancer treatment, targeted immunotherapy in-hibits negative regulatory factors and enhances systemic anti-tumor immune effects. Radiotherapy not only kills tumor cells, but also en-hances systemic immune responses. Recent studies showed that targeted immunotherapy combined with radiotherapy can promote con-trol on local and distant tumors and prolong overall survival. The synergistic effects of these two therapies are superior to a single thera-py. This review summarized the progress on these research fields.