Comentario acerca del caso Belcebú / Commentary on the Beelzebub case / Commentaire sur le cas clinique de Belzébuth / Comentário sobre o caso Belzebu

A partir de la presentación del caso clínico de un niño de 10 años llamado Belcebú, atendido durante la pandemia de forma virtual a lo largo de un año y cuatro meses, se realiza un comentario teórico-clínico puntualizando los aspectos vinculados a:los enunciados identificatorios; el niño en la estructura familiar y, como aspecto más relevante, el lugar del juego producido en las sesiones, el que sostenido por la mirada posibilitadora de la analista, le permitió alniño elaborar y rescribir marcas identitarias,en pos de una subjetivación menos tanática AU

Based on the presentation of the clinical case of a 10-year-old boy named Belcebú, treated virtually during the pandemic for a yearand four months, a theoretical-clinical comment is made, pointing out the aspects related to: the identifying statements; the child in the family structure and, as a most relevant aspect, the place of the play produced in the sessions, which, supported by the analyst's enabling gaze, allowed the child to elaborate and rewrite identity marks, in pursuit of a less thanatic subjectivation AU

Sur la base de la présentation du cas clinique d'un garçon de 10 ans nommé Belcebú, traité virtuellement pendant la pandémie durant un an et quatre mois, un commentaire théorico-clinique est fait, soulignant les aspects liés:aux énoncés identifiants; l'enfant dans la structure familiale et, comme aspect le plus pertinent, la place du jeu produit dans les séances, qui, soutenu par le regard habilitant de l'analyste, a permis à l'enfant d'élaborer et de réécrire des marques identitaires, à la poursuite d'une subjectivation moins thanatique AU

A partir da apresentação do caso clínico de um menino de 10 anos chamado Belcebú, tratado virtualmente durante a pandemia por um ano e quatro meses, é feito um comentário teórico-clínico, apontando os aspectos relacionados: a os depoimentos identificadores; a criança na estrutura familiar e, como aspecto mais relevante, o lugar da brincadeira produzida nas sessões, que, amparada pelo olhar capacitador do analista, permitiu à criança elaborar e reescrever marcas identitárias, em busca de uma subjetivação menos tanática AU

Mutations of PTCH1 gene in two pedigrees with bifid rib-basal cell nevus-jaw cyst syndrome / 浙江大学学报·医学版

Two male patients with bifid rib-basal cell nevus-jaw cyst syndrome (BCNS) were admitted to Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College due to radiological findings of multiple low density shadows in the jaw. Clinical and imaging findings showed thoracic malformation, calcification of the tentorium cerebellum and falx cerebrum as well as widening of the orbital distance. Whole exon high-throughput sequencing was performed in two patients and their family members. The heterozygous mutations of c.C2541C>A(p.Y847X) and c.C1501C>T(p.Q501X) in PTCH1 gene were detected in both patients. Diagnosis of BCNS was confirmed. The heterozygous mutations of PTCH1 gene locus were also found in the mothers of the two probands. Proband 1 showed clinical manifestations of low intelligence, and heterozygous mutations of c.C2141T(p.P714L) and c.G3343A(p.V1115I) were detected in FANCD2 gene. Proband 2 had normal intelligence and no FANCD2 mutation. The fenestration decompression and curettage of jaw cyst were performed in both patients. Regular follow-up showed good bone growth at the original lesion, and no recurrence has been observed so far.

Study on the Construction of Harmonious Doctor-patient Relationship under the Family Doctor Contract Service System / 中国医学伦理学

【Objective:】 To understand the current status and problems of the doctor-patient relationship under the family doctor contract service system through the investigation on residents contracted by community family doctors, and to provide reference for constructing harmonious doctor-patient relationship and promoting the healthy operation of the family doctor contract service system. 【Methods:】 A questionnaire survey was conducted on 1 655 residents of a certain university community in Xi’an from January to February 2023 who completed family doctor contract services in 2022. Through the general situation of signed residents, the willingness of signed family doctors, and the satisfaction and opinions with signed family doctors’ services, this paper investigated the current status of the doctor-patient relationship and proposed corresponding improvement strategies. 【Results:】 A total of 856 residents(52.68%) were willing to sign the contract, 322 residents(19.82%) were unwilling to sign the contract, 397 residents(24.43%) expressed indifference, and 50 residents(3.07%) abstained from signing the contract. There was no statistical difference in service satisfaction between residents of different genders(P=0.292). The satisfaction of working staff aged 40-60(72.33%) was higher than that of retirees aged over 60(61.05%, P<0.001). The satisfaction of those with bachelor’s degree or above(58.23%) was higher than that of those with bachelor’s degree below(51.77%, P=0.008). The satisfaction of individuals living alone(70.21%) was significantly higher than that of non-solitary individuals(54.35%, P<0.001). The overall satisfaction score of contracted residents with contracted services was(4.48±0.14) points, including 4.31 points for satisfaction with service methods, 4.47 points for satisfaction with service attitudes, 4.52 points for satisfaction with service content, and 4.60 points for satisfaction with service effectiveness. 【Conclusion:】 Most community residents have a positive attitude towards family doctor contract services. Improving service satisfaction and strengthening doctor-patient communication are feasible ways to improve grassroots doctor-patient relationships and promote the operation of the family doctor contract service system.

Ocio familiar en tiempos de confinamiento: construcción y validación de un instrumento / Family leisure during lockdowns: Construction and validation of an instrument / Lazer em família em tempos de confinamento: Construção e validação de um instrumento

Resumen (analítico) La revalorización experimentada por el ocio en los contextos familiares, debido a las restricciones sociales que han conllevado un incremento del tiempo en casa, ha contribuido a que esta emerja con fuerza como línea de investigación educativa, pues hasta ahora se encontraba desatendida en el panorama español. En el presente estudio se diseña y valida el Cuestionario sobre ocio familiar durante el confinamiento. Para dotar de validez de contenido y consistencia al constructo, se contó con el juicio de 10 expertos sobre la claridad, pertinencia y adecuación del instrumento, mediante una escala de validación. Los resultados denotan que el cuestionario resultante (61 ítems) posee propiedades psicométricas adecuadas que lo convierten en una herramienta apropiada para evaluar el ocio familiar, quedando confirmado su rigor y valía como correcto instrumento de análisis.

Abstract (analytical) The revaluation of leisure in family contexts, caused by lockdowns imposed during the COVID-19 pandemic that led to an increase in time spent at home, has contributed to this area emerging as a focus of educational research, which until now had been neglected in Spanish-speaking countries. In the present study, the authors present the process of designing and validating a "Questionnaire on family leisure during lockdowns". In order to provide content validity and consistency to the design of the instrument, feedback from 10 experts assessed the clarity, relevance and suitability of the instrument using a validation scale. The results show that the questionnaire, with 61 questions, has sufficient psychometric properties that make it an appropriate tool to evaluate family leisure. During this process the authors confirmed its rigor and value as an analytical instrument for research.

Resumo (analítico) A revalorização vivenciada pelo lazer em contextos familiares, devido às restrições sociais que têm levado ao aumento do tempo em casa, tem contribuído para o seu surgimento fortemente como uma linha de pesquisa educacional, já que até então era negligenciada no cenário espanhol. No presente estudo, o "Questionário sobre lazer familiar durante o confinamento" é elaborado e validado. Para conferir validade de conteúdo e consistência ao construto, o julgamento de 10 especialistas contou com a clareza, pertinência e adequação do instrumento, por meio de uma escala de validação. Os resultados mostram que o questionário resultante (61 itens) possui propriedades psicométricas adequadas que o tornam um instrumento adequado para avaliar o lazer familiar, confirmando seu rigor e valor como um correto instrumento de análise.

Caracterización del desempeño profesional del médico de familia en nefrogeriatría en Consolación del Sur / Characterization of the Professional Performance of the family Physician in Nephrogeriatrics in Consolación del Sur Municipality

Introducción: La atención a pacientes nefrogeriátricos requiere de nuevas acciones que propicien mejores resultados de forma armónica e integrada. Objetivo: Caracterizar el estado actual del desempeño profesional del médico de familia en nefrogeriatría en la Atención Primaria de Salud. Métodos: Estudio observacional, descriptivo y transversal, desde mayo de 2014 a mayo de 2015, dirigido a 39 médicos de familia del área 5 de septiembre. Se emplearon métodos teóricos, empíricos y estadísticos para evaluar el desempeño profesional del médico de familia en nefrogeriatría. Se tuvo en cuenta el consentimiento informado. Resultados: Se identificó el estado actual de la variable estudiada, con la identificación de problemas relacionados con la dimensión cognitiva, asistencial, educativa e investigativa en la atención al paciente nefrogeriátrico en la Atención Primaria de Salud. Conclusiones: El desempeño profesional del médico de familia en nefrogeriatría carece de integración en la atención integral a los pacientes, la familia y la comunidad(AU)

Introduction: The care for nephrogeriatric patients requires new actions with better outcomes in a harmonic and integrated way. Objective: To characterize the current state of professional performance of family physicians in nephrogeriatrics in primary healthcare. Methods: Observational, descriptive and cross-sectional study carried out from May 2014 to May 2015, targeted at 39 family physicians belonging to 5 de Septiembre health area. Theoretical, empirical and statistical methods were used to evaluate the professional performance of the family physician in nephrogeriatrics. Informed consent was taken into account. Results: The current state of the studied variable was identified, with the identification of problems related to the cognitive, assistance, educational and investigative dimensions in the care of nephrogeriatric patients in primary healthcare. Conclusions: The professional performance of the family physician in nephrogeriatrics lacks integration regarding the comprehensive care of patients, family and the community(AU)

Planejamento estratégico de um programa de pós-graduação em rede: experiência de construção coletiva / Strategic planning of a network-based graduate health program: an experience of participatory planning / Planificación estratégica de un programa de posgrado en red: experiencia de construcción colectiva

Trata-se do relato da elaboração do plano estratégico 2021-2024 do Programa de Pós-Graduação em Saúde da Família da Rede Nordeste de Formação em Saúde da Família. Desenvolvido em 2020, o plano visa ao fortalecimento do programa a partir do trabalho coletivo, que valoriza o conjunto e as especificidades. Três perguntas orientaram esta sistematização: Em que contexto aconteceu a experiência? Como se deu o percurso metodológico dos sujeitos, em rede formativa, fazendo o caminho ao caminhar? Como as três partes fundamentais de um plano são interligadas formando um todo? As narrativas expressam uma experiência participativa de planejamento. Esse caminho mobilizou a rede para uma ação educativa e estratégica, tornando vivos o respeito, a diversidade cultural e a cooperação. Considera-se o percurso efetivo, resultando em um documento que orientará o programa no quadriênio.(AU)

This article provides an account of the elaboration of the 2021-2024 strategic plan of the Graduate Program in Family Health offered by the Northeast Family Health Education Network. Developed in 2020, the plan aims to strengthen the Program by promoting collective working that emphasizes a holistic approach and specificities. The study was guided by three key questions: In what context did the experience take place? What was the methodological path taken by the subjects in the training network built as they went along? How are the three fundamental parts of a plan linked together to form a whole? The narratives express a participatory planning experience. This pathway mobilized the network around an educational and strategic action, bringing respect, cultural diversity and cooperation to life. The findings show that the pathway was effective, resulting in a guiding document for the program for the four-year period.(AU)

Es el relato de la elaboración del plan estratégico 2021-2024 del Programa de Posgrado en Salud de la Familia de la Red Nordeste de Formación en Salud de la Familia. Desarrollado en 2020, el plan tiene el objetivo de fortalecer el Programa a partir del trabajo colectivo, que valoriza el conjunto y las especificidades. Tres preguntas orientaron esta sistematización: ¿En qué contexto sucedió la experiencia? ¿Cómo se realizó la jornada metodológica de los sujetos, en red formativa, haciendo camino al andar? ¿Cómo las tres partes fundamentales de un plan se interconectan formando un todo? Las narrativas expresan una experiencia participativa de planificación. Ese camino movilizó la red hacia una acción educativa y estratégica, dando vida al respeto, la diversidad cultural y la cooperación. Se considera la jornada efectiva, resultado en un documento que orientará el Programa en el cuadrienio.(AU)

Cronicidad, violencia y longitud de trayectoria criminal. Hombres detenidos por violencia doméstica / Chronicity, violence and criminal trajectory length. Men arrested for domestic violence

Resumen Los delincuentes crónicos resultan ser los responsables de la mayor parte de la actividad criminal, además de ser los más persistentes y violentos. Existe escasa evidencia longitudinal que permita conocer cómo se manifiesta la cronicidad en agresores de violencia doméstica. El objetivo de esta investigación es identificar el criterio más adecuado para diferenciar a los hombres crónicos y establecer la relación que existe entre cronicidad, violencia, versatilidad y duración de la carrera criminal en 10 505 hombres chilenos detenidos por delitos de violencia en el ámbito familiar en el 2007, con base en todas las nuevas detenciones producidas los siguientes diez años. El diseño es longitudinal pseudoprospectivo, tal como si correspondiera a un estudio longitudinal prospectivo. Los resultados muestran que tres o más delitos bastan para identificar adecuadamente carreras criminales crónicas, y que un 12.7% del total de hombres pueden considerarse graves, violentos y crónicos, al presentar una trayectoria criminal de entre ocho y diez años, ser responsables de más del 37% del total de las reincidencias, alcanzar un promedio de delitos significativamente alto y versátiles, así como una elevada prevalencia en delitos violentos.

Abstract Chronical criminals turn out to be responsible of most of the criminal activity, in addition to being the most persistent and violent. There exists limited longitudinal evidence that allows knowing how chronicity manifests itself in domestic violence aggressors. The objective of this investigation is to identify the most appropriate criteria to differentiate chronic men and establish the relationship between chronicity, violence and duration of the criminal career in 10 505 Chilean men arrested for domestic violence crimes in 2007, based on all new arrests produced the next 10 years. The design is a longitudinal pseudo-prospective, as if it corresponded to a prospective longitudinal study. The results show that three or more crimes are enough to properly identify chronic criminal careers, and that 12.7% of all men can be considered as serious, violent and chronic, presenting a criminal trajectory between eight and ten years, being responsible for more than 37% of total recidivism, reach a significantly high average of crimes and high prevalence of violent crimes.

Repercussions of family violence: oral history of adolescents / Repercusiones de la violencia intrafamiliar: historias orales de adolescentes / Repercussões da violência intrafamiliar: história oral de adolescentes

ABSTRACT Objective: To know the repercussions of the experience of family violence from the oral history of adolescents. Method: Qualitative study based on the Oral History method, conducted from interviews with adolescents enrolled in a public school in Salvador, State of Bahia, Brazil. The data were systematized according to the thematic analysis and supported by theoretical references on family violence and adolescence. Results: Family violence implies physical illness associated with the damage caused by physical aggression and somatization of violent events, as well as compromising mental health, provoking feelings of deep sadness, self-injury behavior and suicidal ideation. All of these factors impair interpersonal relationships, school performance, as well as making them more vulnerable to alcohol intake. Final Considerations: The study indicates signs suggestive of grievance, from which the professionals should proceed the investigation in order to refute or confirm the experience of the phenomenon, as well as intervene in the cases.

RESUMEN Objetivo: Conocer las repercusiones derivadas de la violencia intrafamiliar a partir de historias orales de adolescentes. Método: Se trata de una investigación cualitativa basada en el método de la Historia Oral, realizada mediante entrevistas a alumnos adolescentes de una escuela pública de Salvador, Bahía, Brasil. Se sistematizaron los datos según el análisis temático con respaldo en referenciales teóricos sobre violencia intrafamiliar y adolescencia. Resultados: La violencia intrafamiliar trae como consecuencia enfermedades asociadas a la agresión física padecida, somatizando el penoso evento y comprometiendo la salud mental, ya que suscita sentimientos de profunda tristeza, comportamiento de autolesión e ideas suicidas. Todos estos factores perjudican las relaciones interpersonales, el rendimiento escolar y propician el uso del alcohol. Consideraciones Finales: El estudio señala la existencia del agravio, a partir del cual los profesionales deben realizar investigaciones en el sentido de refutar o confirmar la vivencia del fenómeno e intervenir en los casos.

RESUMO Objetivo: Conhecer as repercussões da vivência de violência intrafamiliar a partir da história oral de adolescentes. Método: Pesquisa qualitativa, fundamentada no método da História Oral, realizada a partir de entrevistas com adolescentes matriculadas(os) em uma escola pública de Salvador, Bahia, Brasil. Os dados foram sistematizados conforme a análise temática e respaldados em referenciais teóricos sobre violência intrafamiliar e adolescência. Resultados: A violência intrafamiliar implica adoecimento físico associado aos danos decorrentes da agressão física e à somatização do evento violento, bem como compromete a saúde mental, suscitando sentimentos de tristeza profunda, comportamento de autolesão e ideação suicida. Todos esses fatores prejudicam as relações interpessoais, o desempenho escolar, bem como vulnerabiliza para o uso de álcool. Considerações Finais: O estudo aponta sinais sugestivos do agravo, a partir dos quais os profissionais deverão proceder a investigação no sentido de refutar ou confirmar a vivência do fenômeno, bem como intervir diante dos casos.

Tensões e contradições da proteção social na fronteira da assistência com a saúde / Tensions and contradictions of the social protection at the frontier between assistance and health / Tensiones y contradiciones de la protección social en la frontera entre la asistencia y la salud

Resumo Neste artigo propomos uma reflexão acerca das transformações operadas na proteção social brasileira, em que pesem avanços e desafios da interlocução do Programa Bolsa Família com a saúde. Para tal, explora-se a dimensão simbólica dos discursos de beneficiários e gestores do Programa Bolsa Família, além de trabalhadores da atenção primária. O artigo tem como base um estudo de caso de abordagem qualitativa desenvolvido em um município da região sudoeste da Bahia, em 2015, por meio de 26 entrevistas e três grupos focais (29 participantes). As falas materializam avanços do Programa Bolsa Família no enfrentamento da pobreza, sobretudo em situações de penúria material, além de efeitos no reconhecimento social e na dignidade de mulheres beneficiárias. Constataram-se limites em aprimorar a dimensão estruturante do programa via sua interlocução com o setor saúde. Estigmas e incompreensões ligados ao Programa Bolsa Família permeiam as relações entre beneficiários e trabalhadores da atenção primária à saúde. Tais questões limitam a assunção de vulnerabilidades vividas cotidianamente pelas famílias do Programa Bolsa Família como determinantes do processo de trabalho na atenção primária à saúde, ainda restrito ao acompanhamento de condicionalidades da saúde.

Abstract In this article we propose a reflection regarding the transformations that occurred in Brazilian social protection, in spite of the advances and challenges of the dialogue between health and the Family Support Grant Program. In order to do so, we explored the symbolic dimension of the discourses of the beneficiaries and managers of the Family Support Grant Program, as well as of the primary health care workers. The article is based on a case study with a qualitative approach conducted in a municipality in the Southwestern region of the state of Bahia, Brazil, in 2015, through 26 interviews and three focus groups (29 participants). The statements described the advances of the Family Support Grant Program in fighting poverty, especially in situations of material poverty, as well as the effects on social recognition and dignity of the female beneficiaries. We verified limits to improve the structuring dimension of the program via its dialogue with the health sector. Stigmas and incomprehension connected to the Family Support Grant Program permeate the relationships between beneficiaries and primary health care workers. These issues hinder the acceptance of the vulnerabilities experienced on a daily basis by the families of the Family Support Grant Program as determinants of the work process in primary health care, which is still restricted to the follow-up of health conditionalities.

Resumen En este artículo proponemos una reflexión sobre las transformaciones operadas en la protección social brasileña, a pesar de los progresos y retos de la interlocución del Programa de Subvención a la Familia con la salud. Para eso, se explora la dimensión simbólica de los discursos de los beneficiarios y gestores del Programa de Subvención a la Familia, y la de los trabajadores de la atención primaria. El artículo está basado en un estudio de caso de abordaje cualitativo desarrollado en un municipio de la región Suroeste del estado de Bahía, Brasil, en 2015, por medio de 26 entrevistas y tres grupos focales (29 participantes). Las declaraciones materializan los progresos del Programa de Subvención a la Familia en la lucha contra la pobreza, sobretodo en situaciones de penuria material, más allá de los efectos en el reconocimiento social y en la dignidad de las mujeres beneficiarias. Se constataron límites para mejorar la dimensión estructurante del programa por medio de su interlocución con el sector de salud. Estigmas e incomprensiones relacionadas al Programa de Subvención a la Familia permean las relaciones entre beneficiarios y trabajadores de la atención primaria de salud. Esas cuestiones limitan la asunción de las vulnerabilidades vividas cotidianamente por las familias del Programa de Subvención a la Familia como determinantes del proceso de trabajo en la atención primaria de salud, aún restringido al seguimiento de condicionalidades de la salud.

Dinâmicas sociais, familiares e vulnerabilidades de mulheres privadas de liberdade / Social and family dynamics and vulnerabilit y of incarcerated females

O objetivo deste trabalho foi identificar as dinâmicas familiares, sociais e vulnerabilidades de mulheres privadas de liberdade. Estudo descritivo, exploratório e misto, realizado com 57 reeducandas de uma cadeia pública feminina de Mato Grosso. A coleta de dados foi realizada entre outubro de 2016 e outubro de 2017. A análise dos dados pautou-se no Modelo Calgary de Avaliação da Família. Entre as características familiares da estrutura interna e externa predominaram heterossexuais, com estrutura familiar coletiva, residiam com os familiares antes do aprisionamento e com seus filhos. O ciclo de vida familiar era caracterizado por adultos com crianças, e ordem de nascimento intermediária. Os limites da família foram descritos como flexíveis e a totalidade das reeducandas exercem papel passivo na estrutura familiar. Prevaleceu famílias extensas, com alguma crença religiosa, com destaque para relato de ambientes familiares harmoniosos. As características familiares desestruturadas foram identificadas como importante aspecto, que contribui para inserção da mulher no crime.

Family and social dynamics and vulnerabilities of incarcerated females are analyzed. Current descriptive, exploratory and mixed study was undertaken with 57 incarcerated females in the female prison of Mato Grosso. Data were collected between October 2016 and October 2017. Data analysis was based on the Calgary Model of Family Evaluation. Among internal and external structure family characteristics, heterosexuals were predominant, with collective family structure, living with parents and with their children prior to incarceration. Family life cycle was characterized by adults with children and intermediate birth order. Family limits were described flexible and totality of incarcerated females have a passive role in family structure. Extensive families were dominant, with some religious beliefs, insisting on narratives of harmonious family environments. De-structured family characteristics were identified as an important aspect that pushes the female into crime.

Life History and Personality Characteristics of Marital Aggressors: Psychoanalytic Contributions / História de Vida e Características de Personalidade de Agressores Conjugais: Contribuições Psicanalíticas / Historia de Vida y Características de Personalidad de Agresores Conjugales: Contribuciones Psicoanalíticas

Abstract Research indicates that trauma (sexual, physical, and emotional abuse) is a factor commonly present in the life of marital abusers. This study aimed to investigate the life history characteristics and personality of men who perpetrated violence against women and were detained in the Central Prison of Porto Alegre, Brazil. We also identified sociodemographic characteristics, the presence of psychopathological symptoms and understood the intrapsychic dynamics involved in the participants' marital choice, as well as their perception regarding the experience of detention. Three participants filled out a personal data sheet, answered the Rorschach method, the MINI Interview, and participated in three semi-structured interviews. The interviews were examined from the interpretative analysis technique based on psychoanalytic theory. The results allow us to understand the violence committed by the participants as a result from a life story marked by traumatic experiences that produced narcissistic flaws and the expression of aggressiveness.

Resumo Pesquisas indicam que o trauma (abuso emocional, físico e sexual) é um fator comumente presente ao longo da vida de agressores conjugais. Este estudo objetivou investigar as características da história de vida e de personalidade de homens que perpetraram violência contra a mulher e estavam detidos no Presídio Central de Porto Alegre. Identificou-se também características sociodemográficas, a presença de sintomas psicopatológicos e se compreendeu a dinâmica intrapsíquica envolvida na escolha conjugal dos participantes, bem como a percepção deles a respeito da vivência de detenção. Três participantes preencheram uma ficha de dados pessoais, responderam ao Método de Rorschach, a Entrevista MINI e participaram de três entrevistas semiestruturadas. As entrevistas foram examinadas a partir da técnica de análise interpretativa baseada na teoria psicanalítica. Os resultados permitem compreender a violência cometida pelos participantes como decorrente de uma história de vida marcada por vivências traumáticas que produziram falhas narcísicas e a expressão da agressividade.

Resumen Los estudios apuntan que el trauma -ocasionado por abuso emocional, físico y sexual- es un factor comúnmente presente a lo largo de la vida de los agresores conyugales. El presente estudio objetivó investigar las características de la historia de vida y de personalidad de hombres quienes habían cometido violencia contra la mujer y que estaban detenidos en el Presidio Central de Porto Alegre. También se identificaron las características sociodemográficas, la presencia de síntomas psicopatológicos, y se comprendió la dinámica intrapsíquica involucrada en la elección conyugal de los participantes, así como su percepción acerca de la vivencia en la prisión. Tres participantes llenaron una hoja con datos personales, respondieron al método de Rorschach, la entrevista MINI y participaron en tres entrevistas semiestructuradas. Se analizaron las entrevistas por medio del análisis interpretativo con base en la teoría psicoanalítica. Los resultados permiten apuntar que la violencia cometida por los participantes es consecuencia de una historia de vida marcada por vivencias traumáticas que les produjeron fallas narcisistas y la manifestación de agresividad.

Prácticas educativas familiares (PEF) de familias en condición de extrema pobreza en Cartagena de Indias / Family Educational Practices (PEF) of families in extreme poverty conditions in Cartagena de Indias

Resumen Las prácticas educativas familiares, en el estudio realizado en la ciudad de Cartagena de Indias con familias en condición de pobreza extrema, nos permitió identificar los estilos educativos empleados gracias a los encuentros significativos estructurados desde un enfoque hermenéutico-participativo, donde fue posible analizar las narrativas de los participantes, habitantes del barrio Ciudad del Bicentenario. Este ejercicio investigativo nos reveló las costumbres, actitudes y formas que tienen los padres para orientar la crianza de sus hijos. Así mismo nos permitió registrar algunas de las necesidades del grupo participante.

Abstract The Family Educational Practices, in the study conducted in the city of Cartagena de Indias with families in extreme poverty condition, allowed us to identify the educational styles used thanks to the meaningful encounters, which were structured from a hermeneutic and participatory approach, where it was possible to analyze participants' narratives, who were residents of the Ciudad del Bicentenario neighborhood. This investigative exercise revealed the customs, attitudes and ways that parents have for their children's upbringing. Likewise, it allowed us to record some of the participant group's needs.

Posttraumatic Growth from Bereavement and Other Related Factors among the Family Members of Deceased Cancer Patients at a General Ward

Objective: This study aimed to evaluate posttraumatic growth (PTG) from bereavement and other related factors among family members of deceased cancer patients who had been admitted to a general ward. Methods: A self-administered questionnaire was mailed to 42 bereaved family members who agreed to participate in the present study. The time from the death of their loved ones was between one and four years. Results: Of 42, 37 returned their responses. The average PTGI total score was 2.63, which was consistent with previous studies examined the scores at a general hospital and palliative care units. The PTGI was positively correlated with the emotion focus type coping, the recognition estimating support, and the emotional support. The PTGI of the bereaved whose loved ones underwent medical treatment at home was significantly higher than the score of the bereaved whose loved ones passed away at general ward. Conclusion: It is crucial to evaluate whether or not the bereaved experienced a healthy grieving process, and if they received social support. Moreover, it is important to provide the information regarding where the support is offered to the bereaved. Additionally, clinicians need to improve the support system so that the cancer patients can undergo medical treatment at home.

Research progress of new mumber HHLA2 of B7 family / 中国免疫学杂志

HHLA2 is a newly discovered B7 family member.HHLA2 appears to have limited expression in normal tissues.TMIGD,one of the receptors HHLA2 is established.Similar to HHLA2,TMIGD2 is absent in mouse and rat while it is found in human and higher primates.HHLA2 with inhibition of CD4 and CD8 T cell proliferation,but also can inhibit the role of T cells secrete some cytokines.HHLA2 protein is absent in most normal tissues,but mainly expressed on epithelial cells of a few tissues.But HHLA2 is widely expressed in various human cancers such as lung cancer,breast cancer and osteosarcoma et al,that make HHLA2 might be a new target for human cancers immunotherapy.

Potencialidades e limites da visita domiciliar para identificar e abordar mulheres em situação de violência / Potential and limits of home visits to identify and address women in situation of violence / Potencialidades y límites de la visita domiciliaria para identificar y abordar a mujeres ensituación de violencia

Este estudo objetivou apreender potencialidades e limites da visita domiciliar para identificar e abordar mulheres em situação de violência. Trata-se de uma pesquisa participante da qual participaram 38 profissionais (enfermeiros, técnicos de enfermagem e agentes comunitários de saúde) de seis equipes da Estratégia Saúde da Família de um município localizado na região Noroeste do Rio Grande do Sul, Brasil. A produção dos dados ocorreu entre novembro de 2015 e março de 2016, a partir de seis oficinas pedagógicas. Os dados foram analisados mediante análise temática. A visita domiciliar é potencial para identificar situações de violência contra as mulheres e observar as relações conjugais e familiares no ambiente doméstico. Como limites, constatou-se a presença do agressor e de familiares, a sobrecarga de trabalho na unidade e pouco tempo para abordar a questão. Para superá-los, os profissionais apontaram a criação de uma atmosfera privada e segura como proposta a ser efetivada através da persistência e planejamento das visitas. Incluir a visita domiciliar como tecnologia leve-dura voltada às mulheres em situação de violência como rotina na Estratégia Saúde da Família possibilita aprimorá-la como técnica de abordagem do problema. [AU]

This study aimed to capture the potential and limits of home visits to identify and address women in situation of violence. It is a participant research with 38 professionals (nurses, nursing and community health agents) of six teams from the Family Health Strategy of a municipality located in the northwestern region of Rio Grande do Sul, Brazil. The data production occurred between November 2015 and March 2016, from six educational workshops. Data were analyzed by means of thematic analysis. The home visit is potential to identify situations of violence against women and observe the marital and family relations at home. The limits of the research were the presence of the aggressor and relatives, the workload in the unit and short time to address the issue. To overcome them, professionals identified that creating a private and secure atmosphere can be a proposal to be carried out through persistent and planned visits. Including the home visits as hard-light technology geared to women in situation of violence as a routine in the Family Health Strategy, may be a technique to approach the problem. [AU]

Este estudio tuvo el objetivo de comprender potencialidades y límites de la visita domiciliaria para identificar y abordar a mujeres en situación de violencia. Se trata de una investigación participante de la cual hicieron parte treinta y ocho profesionales (enfermeros, técnicos de enfermería y agentes comunitarios de salud) de seis equipos de la Estrategia Salud de la Familia de un municipio ubicado en la región Noroeste del Rio Grande do Sul, Brasil. La producción de los datos ocurrió entre noviembre de 2015 y marzo de 2016, a partir de seis talleres pedagógicos. Los datos fueron analizados por medio de análisis temático. La visita domiciliaria es potencial para identificar situaciones de violencia contra las mujeres y observar las relaciones conyugales y familiares en el ambiente doméstico. Como límites, se constató la presencia del agresor y de familiares, la sobrecarga de trabajo en la unidad y poco tiempo para abordar la cuestión. Para superarlos, los profesionales indicaron la creación de una atmósfera privada y segura como propuesta para llevarse a cabo a través de la persistencia y planificación de las visitas. Incluir la visita domiciliaria como tecnología blanda-dura dirigida a las mujeres en situación de violencia como rutina en la Estrategia Salud de la Familia posibilita perfeccionarla como técnica de abordaje del problema. [AU]

El impacto familiar en pacientes con epilepsia benigna de la infancia / Family impact on children with benign childhood epilepsy

La epilepsia constituye un factor de estrés en la vida del niño y su familia. Ambos deben desarrollar estrategias de afrontamiento dentro de un sistema que incluye al niño, a su familia y al entorno social, educativo y médico, y que no siempre resultan adaptativas. Si bien en el ámbito internacional se han realizado numerosos estudios que han podido demostrar que muchos niños con epilepsia ven afectadas sus funciones mentales, sus emociones y conducta; muy pocas investigaciones se propusieron explorar la relación existente entre psicopatología y tipo de epilepsia. En el caso de la Epilepsia Benigna de la Infancia (E.B.I.), no se dispone información sistemática que permita esclarecer su relación con trastornos psicopatológicos en niños, ni tampoco la repercusión de la enfermedad en la familia. El impacto que los trastornos epilépticos pueden tener sobre la vida del niño y su familia es un dato de observación clínica hallado en forma frecuente, durante el seguimiento de estos pacientes. Es común encontrar que muchos padres de niños epilépticos se vuelven sobreprotectores, restringiendo la actividad del niño y su autonomía. La falta de exposición a situaciones sociales así como una disminución de las expectativas y demandas hacia estos niños pueden dificultar el desarrollo de herramientas adecuadas de interacción social, lo cual repercute negativamente en la autoestima. En algunas ocasiones el status que asume el paciente en esta situación lo limita más aún que la propia epilepsia. Varios estudios han demostrado que el funcionamiento familiar es un poderoso predictor del funcionamiento psicológico en niños con enfermedades crónicas. Este trabajo se propone conocer el impacto de la enfermedad en el grupo de pacientes con epilepsia benigna de la infancia (AU)

Epilepsy is a factor of stress for the child and his or her family. Both need to develop coping strategies within a system that includes the child, the family, and the social, educational, and medical environment, which do not always adapt to the situation. Although multiple international studies have been conducted showing that in many children with epilepsy cognitive function, emotion, and behavior are affected, few studies have evaluated the association between psychopathology and type of epilepsy. In benign childhood epilepsy (BCI) there are no systematic data to clarify its association with psychopathological disorders in children or the impact of the disease on the family. The impact these epileptic disorders have on the life of the child and their family is an often observed clinical finding in the follow-up of these patients. The parents of children with epilepsy often become overprotective, limiting the activities and autonomy of the child. The lack of exposure in social settings as well as decreased expectations and demands from the parents affect the development of adequate social interaction tools with a negative impact on self-esteem. The latter of which may limit the patient more than the epilepsy itself. Several studies have shown that family functioning is a powerful predictor of psychological performance of children with chronic diseases. The aim of the present study was to evaluate the impact of the disease in a cohort of patients with BCE (AU)

La superación profesional en salud ocupacional como una necesidad para la atención médica integral / Professional upgrading in occupational health as a need for comprehensive medical care

Introducción: el proceso de superación constituye una vía primordial para que de manera gradual los profesionales coadyuven a la solución de las insuficiencias académicas en determinados temas y favorezcan el bienestar social. Objetivo: reflexionar sobre la necesidad de la superación profesional del médico de familia en materia de salud ocupacional para prestar una atención médica integral al trabajador. Métodos: estudio cualitativo de carácter descriptivo; donde se emplearon el análisis documental, la sistematización, el análisis y síntesis de revisiones bibliográficas sobre la temática estudiada como métodos teóricos, para ello se valoran los criterios de autores y resultados que se expresan en artículos publicados en revistas indexadas en diferentes bases de datos. Resultados: se abordó sobre la importancia de la superación profesional en salud ocupacional por parte del médico de familia para ofrecer una respuesta oportuna a las demandas sociales de salud de los trabajadores; con la finalidad de fomentar y mantener el más alto nivel de bienestar físico, mental y social en todas las profesiones. Conclusiones: la superación profesional del médico de familia debe estar concebida a partir del diagnóstico científico del estado actual de preparación; en la que se incluyan las vías para la determinación de necesidades de aprendizaje sobre la repercusión en la salud de los factores de riesgo presentes en el ambiente laboral(AU)

Introduction: The upgrading process is an essential way for gradually the professionals to manage with the academic deficiencies in certain issues and to favor social welfare. Objective: To reflect about the need for the professional upgrading of the family doctor regarding occupational health to provide comprehensive medical care to the worker. Methods: Qualitative study of descriptive character, which used, as theoretical methods, documentary analysis, systematization, analysis and synthesis of bibliographic reviews on the subject studied, for which the authors' criteria and results are evaluated, which are expressed in articles published in journals indexed in different databases.Results: The importance of professional upgrading in occupational health by the family doctor was addressed, in order to provide a timely response to the social demands of health workers, with the aim of promoting and maintaining the highest level of physical, mental and social well-being in all professions. Conclusions: The professional upgrading of the family doctor should be conceived from the scientific diagnosis of the current state of training, which includes the ways to determine learning needs about the health impact of the risk factors present in the work environment(AU)

Idosas, rede social significativa e o enfrentamento da violência familiar / Elderly, significant social network and coping with violence in the family

O artigo tem como objetivo mapear a rede social significativa de duas idosas vítimas de violência familiar e analisar as características destas redes para o enfrentamento da violência. Para alcançar o objetivo proposto se fez uso da estratégia de estudo de casos. Participaram duas mulheres com 67 e 77 anos, usuárias de uma Unidade Básica de Saúde. Para coleta dos dados foi realizado entrevista semiestruturada e utilizado o Mapa de Rede, composto pelos quadrantes família, amizades, trabalho, comunidade e profissionais e que foram tomados como categorias de análise. Os dados demonstraram que as redes sociais têm a potencialidade para auxiliar as vítimas a romper o silêncio e enfrentar as violências. (AU)

The article aimed to map the significant social network of two elderly victims of violence in the family and analyze the characteristics of these networks to deal with violence. To achieve the proposed goal case study strategy was used. Two women with 67 to 77 years users of a Basic Health Unit participated. Data collection was conducted with semi-structured interviews and Network Map, composed of five quadrants: family, friendships, work, community and health unit professionals, which were taken as analysis categories. The data showed that social networks have the potential to help victims break the silence and confront violence. (AU)

Avaliação do impacto psicossocial do diagnóstico e tratamento do câncer na vida de familiares cuidadores de pacientes em regime de internação hospitalar / Psychosocial assessment of the impact of cancer diagnosis and treatment on the life of family caregivers of hospitalized patients / Evaluación psicosocial del impacto del diagnóstico y tratamiento del cáncer en la vida de los cuidadores familiares de pacientes hospitalizados

diagnóstico de câncer representa um desafio para pacientes, familiares, cuidadores e profissionais de saúde. Nesse contexto é importante voltar o olhar para o familiar cuidador e identificar como ele é afetado pelas suas responsabilidades com o paciente com câncer, para que sejam desenvolvidas alternativas e intervenções adequadas para favorecer sua qualidade de vida e seu bem estar emocional. Este artigo é resultado de uma pesquisa exploratória, utilizando método quantitativo, desenvolvida com a finalidade de avaliar o impacto do processo de cuidar de um parente com câncer durante o período de internação hospitalar. A coleta de dados ocorreu ao longo de quatro meses no Hospital Universitário de Brasília e foram utilizados os seguintes instrumentos: Escala de Ansiedade e Depressão Hospitalar ­ HAD; Caregiver Reaction Assessment (CRA); entrevista estruturada para coleta de dados sociodemográficos da díade e médicos clínicos do paciente. Segundo os dados coletados, foi possível identificar que o estado de humor do paciente ­ ansiedade, depressão e distress ­ mostrou correlação significativa positiva com estado de humor do cuidador, diferente das demais variáveis. Também, um maior nível de sobrecarga no cuidado estava relacionado significativamente com o nível de ansiedade nos pacientes. O estudo sugere que cuidar do estado emocional do paciente pode ter maior impacto na minimização da sobrecarga do cuidador e vice-versa, confirmando a necessidade de compor as equipes com profissionais treinados para o manejo de dificuldades emocionais e, em especial, psico-oncologistas.

The cancer diagnosis represents a challenge for patients, family, parents, family caregivers and health care professionals. In this context, it is important to keep a lookout for the family caregiver and identify how he or she is affected for his or her responsabilities with the patient with cancer disease. It is important to develop alternatives and proper interventions to favor a quality of life and emotional well-being for him or her. This article is the result of a exploratory research, quantitative method, developed with the purpose of evaluate the impact of the process of looking after a relative with cancer during the period of hospital internment. The data collection had been occurred in the course of four months in the University Hospital of Brasília and it had been used the following instruments: Hospital Anxiety and Depression Scale ­ HAD; Caregiver Reaction Assesment (CRA); structured interview to collect social demographic data of the patient and the caregiver and clinical data of the patient. According to the data collection, it has been possible to identify that the state of the mood of the patient - anxiety, depression and emotional distress ­ showed significant correlation with the state of mood of the family caregiver, the others variables had different results. Also, a high level of the family caregiver's overload was related significantly with the level of anxiety in patients. The study sugests that taking care of the emotional state of the patient can have a great impact in minimization of the family caregiver´s overload and vice versa, confirming the need to compose the team with trained professionals to handle emotional difficulties and, especially, psycho-oncologists.

El diagnóstico de cáncer representa un reto para pacientes, familiares, cuidadores y profesionales de la salud. En este contexto, es importante volver la mirada al cuidador familiar e identificar cómo él se ve afectado por sus responsabilidades con el paciente de cáncer, para que puedan ser adoptadas alternativas e intervenciones apropiadas que mejoren su calidad de vida y su bien estar emocional. Este artículo es el resultado de una investigación exploratoria, utilizando el método cuantitativo desarrollado con el propósito de evaluar el impacto del proceso de cuidar a un familiar con cáncer durante su estancia en el hospital. La recolección de datos se llevó a cabo durante cuatro meses en el Hospital de la Universidad de Brasilia y se utilizaron los siguientes instrumentos: Escala de Ansiedad y Depresión en el Hospital - HAD; Caregiver Reaction Assessment (CRA); entrevista estructurada para recopilar datos sociales y demográficos de la díada y médicos clínicos del paciente. De acuerdo con los datos recogidos, fue posible identificar que el estado de ánimo del paciente - la ansiedad, la depresión y la angustia - mostró una correlación positiva significativa con el estado de ánimo del cuidador, diferente de las otras variables. Asimismo, un mayor nivel de sobrecarga en la atención estaba relacionado significativamente con el nivel de ansiedad en los pacientes. El estudio sugiere que el cuidado con el estado emocional del paciente puede tener un impacto más grande en la reducción de la sobrecarga del cuidador y viceversa, lo que confirma la necesidad de componer los equipos con profesionales capacitados para el manejo de dificultades emocionales y, en particular, psico-oncólogos.

Feasibility Analysis and Mode Discussion of Introducing Medical Social Workers into Family Doctor Service / 中国医学伦理学

The family doctor service is an important measure to transform primary health care mode,makes the community health service institutions to take on the gatekeeper role of residents' health and health care costs,and promotes the achievements of hierarchical diagnosis and treatment.At present,there are some difficulties in the process of family doctor service.For example,the construction of the general practitioner team is lagging behind and the residents don't understand the specific contents of the family doctor service well.Medical social workers have both the social work professional skills and medical literacy,which makes them become the effective strength of community health service.Introducing medical social workers by the purchase of the governments,volunteer training,and job settings mode can meet the needs of the development of family doctor service to some extent,and bring in new ideas to the implementation of the family doctor service.