Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.

Outbreak investigation of a campus bacterial dysentery by water source pollution in Lhasa City / 中国学校卫生

Objective@#To investigate risk factors and the nature of the outbreak of bacillary dysentery in Lhasa City, so as to customize targeted prevention and control measures.@*Methods@#Using on site epidemiological investigation, the suspected, probable and confirmed cases of bacillary dysentery in one school and one kindergarten in Lhasa City from June 26 to July 1, 2022 were collected, and additional cases were identified through interview from school staffs and family members, reviewing morning examination records and tracking records of school illness related absence. A case control study was conducted to investigate suspicious meals and drinking raw water, and polymerase chain reaction (PCR) was performed to detect Shigella line nucleic acid fragment in the patients feces, anal swabs, retained food, and terminal water.@*Results@#A total of 55 cases were found in two schools, with the prevalence rate of 15.41% in total and 16.71% in students ( n =53), 7.5% in staff ( n =2). The epidemic curve was suggestive of a point source exposure. The prevalence rate among students who walk to school and students who live in the school showed no difference (16.10%，17.09%)( χ 2=0.05, P >0.05), and the prevalence rate was higher among elementary school students than kindergarten students (19.83%，6.67%)( χ 2=7.13, P <0.05). Case control comparisons showed a direct association between drinking raw water and morbidity in the case and control groups during June 24-26 ( OR=4.01, 95%CI =1.75-9.19, P < 0.05). A total of 23 fecal Shigella nucleic acid positives were detected from the two schools, two from the end water in front of the cafeteria door, and two from sludge in the sewage pipe around the wellhead.@*Conclusions@#The outbreak of bacillary dysentery is caused by the contamination of the pipe network water. Health administrative departments should improve the supervision and management of drinking water health safety, and schools should strengthen the management of water supply facilities for effectively prevent of waterborne infectious disease outbreaks.

Analysis of factors influencing elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa City / 中国学校卫生

Objective@#To explore the prevalence of elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa, and to analyze their association with lifestyle and other factors, so as to provide a basis for the intervention measures targeting elevated blood pressure, overweight and obesity among middle school students in high altitude area.@*Methods@#Using a stratified cluster random sampling method in September 2021, a total of 1 488 Tibetan junior and high students from Lhasa City were investigated with blood pressure measurement, physical examination and questionnaire survey. The influencing factors of elevated blood pressure, overweight and obesity and their comorbidities association were analyzed by multivariate Logistic regression.@*Results@#The prevalence of elevated blood pressure, overweight/obesity and their comorbidities were 17.8%, 17.4% , 5.0% respectively. Multivariate Logistic regression analysis showed that age( OR =0.81), residence, body mass inex(BMI) and gender were the influencing factors of elevated blood pressure; and the risks of elevated blood pressure in female students were higher than male students ( OR =1.89), suburban students were higher than urban students ( OR =8.06), overweight and obesity groups were higher than normal groups ( OR =2.55, 2.87) ( P <0.05). Adjusting for confounding factors such as gender, residence and school, and BMI (only for elevated blood pressure), daily screen time ≥2 h was positively correlated with elevated blood pressure, overweight/obesity and its comorbidities ( OR =1.56, 1.59 , 2.51) ( P <0.05).@*Conclusions@#The prevalence of elevated blood pressure, overweight/obesity are relatively high in Lhasa. Longer screen time is a common factor affecting with elevated blood pressure, overweight/obesity and comorbidities among Tibetan students. Measures should be taken intervene in the lifestyle of Tibetan students, in order to reduce elevated blood pressure and overweight/obesity.

Intervention effects of moderate and high intensities of classroom physical activity on cardiorespiratory fitness and executive function among junior grade one students in Tibetan / 中国学校卫生

Objective@#To explore the intervention effect of different intensity of classroom physical exercise on cardiorespiratory fitness and executive function of Tibetan first grade students at high altitude, so as to provide reference for improving the level of cardiorespiratory fitness and executive function of Tibetan adolescents.@*Methods@#From September to December 2020, 184 Tibetan students from five first grade classes in a middle school in Lhasa, Tibet, were randomly assigned into a control group (81 students in two classes) and an intervention group (103 students in three classes). Both groups followed the same teaching programme, but the intervention group received 36 sessions of moderate to high intensity classroom physical activity, one session per day, Monday,Wednesday and Friday, for 12 weeks. Before and after the intervention, cardiorespiratory fitness and executive function were tested by 20m round trip running and Flanker s experimental paradigm, 2-back s experimental paradigm, and More odd shifting experimental paradigm for inhibitory control, refreshing memory, and switching flexibility, and the results were analysed by analysis of covariance (ANCOVA) to compare the results of the pre and post intervention periods.@*Results@#The maximum oxygen uptake (VO 2max ) of Tibetan first grade students in the intervention group increased by 2.25 mL/(kg〖WW）〗·〖WW(〗min) compared with the control group after the intervention ( t =-3.89, P <0.01); the response time of the inhibitory function was reduced by 4.40 ms, that of the refreshing function by 196.06 ms, and that of the switching function by 92.72 ms in the intervention group compared with the control group ( t =2.98, 4.82 ,3.21, P <0.05).@*Conclusion@#The 12 week moderate to high intensity classroom physical activity intervention has different degrees of improvement effects on cardiorespiratory fitness and executive function in Tibetan adolescents.

Association between latent classes of dietary patterns and depressive symptoms among firstgrade students from multi ethnic middle schools in Yunnan Province / 中国学校卫生

Objective@#To determine the latent class of dietary patterns and their association with depressive symptoms among first grade students from multi ethnic middle schools in Yunnan Province, so as to provide a reference basis for promoting mental health among border middle school students.@*Methods@#A cluster random sampling involving 8 500 first grade middle school students from 11 counties in Yunnan Province was conducted by a questionnaire survey between October to December 2022. The Children s Depression Inventory (CDI) was used to assess the depressive symptoms and the Food Frequency Questionnaire was used to collect eating behavior data. The latent profile analysis model was used to fit the latent class of dietary patterns among students. The association between the dietary pattern latent class and depressive symptoms was analyzed by Logistic regression.@*Results@#The depressive symptom detection rate among firstgrade middle school students was 28.3%. Prevalence of depressive symptom in girls (30.9%) was higher than boys (25.5%) with a statistically significant difference ( χ 2=29.83, P <0.01). The dietary patterns among first grade middle school students were classified into four latent classes, as follows:class 1 (low consumption of all dietary components), class 2 (high consumption of fruit, milk and dairy products), class 3 (high consumption of vegetables and meat, and low consumption of processed foods) and class 4 (low consumption of milk, dairy products and eggs, and high consumption of processed foods). After adjusting for confounding variables, the class 3 dietary pattern was negatively correlated with depressive symptoms ( OR=0.62, 95%CI =0.52-0.74) and the class 4 dietary pattern was positively correlated with depressive symptoms ( OR= 1.28 , 95%CI =1.05-1.57) ( P <0.05), compared with the class 1 dietary pattern.@*Conclusions@#Multi ethnic first grade middle school students in Yunnan Province follow various dietary patterns. Unhealthy dietary patterns increase the risk of depressive symptoms. The dietary patterns of multi ethnic middle school students in Yunnan Province should be adjusted to promote the establishment of healthy dietary patterns and reduce the risk of depression symptoms in middle school students.

Decision tree model of depressive symptoms among first grade students from multi ethnic middle schools in Yunnan Province / 中国学校卫生

Objective@#To understand the occurrence and predictive factors of depressive symptoms among multi ethnic middle school students in Yunnan Province, so as to provide a referential framework for schools to carry out targeted mental health education.@*Methods@#From October to December 2022, 8 500 first grade students from 23 middle schools were selected from 11 minority areas in Yunnan Province by cluster random sampling method. Demographic information and data relating to the students lifestyles were collected by questionnaire, and the Children s Depression Inventory (CDI) was used to evaluate depressive symptoms. Chi square test was performed to compare differences in the detection rate of depressive symptoms among first grade middle school students for univariate analysis. A decision tree model of depressive symptoms in middle school students was established by using the Chi squared automatic interaction detector (CHAID).@*Results@#The detection rate of depressive symptoms among first grade students from multi ethnic middle schools in Yunnan Province was 28.26%. The decision tree model of depressive symptoms was academic stress ( χ 2=469.08) at the first level, breakfast behaviors (low/moderate academic stress: χ 2=155.49; severe academic stress: χ 2=105.24) at the second level, and the number of close friends (low/moderate academic stress and consuming breakfast 0- 2 days weekly: χ 2=23.15; low/moderate academic stress and consuming breakfast 3-4 days weekly: χ 2=14.99; severe academic stress and consuming breakfast 0-2 days weekly: χ 2=29.26; severe academic stress and consuming breakfast 3-4 days weekly: χ 2=20.15), ethnicity ( χ 2=78.22) and drinking ( χ 2=50.36) at the third level ( P <0.01).@*Conclusions@#The study identifies academic stress, breakfast behaviors, number of close friends, drinking and ethnicity as predictive factors of depressive symptoms among multi ethnic middle school students in Yunnan Province. Schools should develop targeted strategies for preventing and managing depressive symptoms in middle school students, so as to reduce their occurrence.

Focus on the dietary behaviors and mental health among multi ethnic adolescents / 中国学校卫生

Abstract@#Unhealthy eating behaviors among adolescents are common, and psychological behavior problems are prominent. The paper examines the status and associations underlying unhealthy eating behaviors and psychological behavior problems in adolescents from border multi ethnic areas, and further discusses the importance of research in border area involving multi ethnic adolescents, and highlights its significance in the context of constructing healthy schools in border areas,so as to provide a basis for promoting effectively healthy school environments in border areas of China.

Association of blood groups/Rh and diabetes mellitus in Karachi city, Pakistan / Associação de grupos sanguíneos/Rh e diabetes mellitus na cidade de Karchi, Paquistão

Abstract The main purpose of this study was to find out a possible association between ABO blood groups or Rh and diabetes mellitus (DM) in the local population of eight (8) different towns of Karachi, Pakistan. For this purpose a survey was carried out in Karachi to have a practical observation of these towns during the period of 9 months from June 2019 to Feb. 2020. Out of eighteen (18) towns of Karachi, samples (N= 584) were collected from only eight (8) Towns of Karachi and gave a code-number to each town. Diabetic group sample was (n1=432) & pre-diabetes sample was (n2 =152). A standard Abbot Company Glucometer for Random Blood Sugar (RBS) and Fasting Blood Sugar (FBS) tests, standard blood anti sera were used for ABO/Rh blood type. Health assessment techniques were performed ethically by taking informed consent from all registered subjects. Finally data was analyzed by SPSS version 20.0. In our current study, the comparison of ABO blood groups frequencies between diabetic and pre-diabetic individuals were carried out. The percentage values of blood Group-B as given as: (32% in DM vs. 31% in pre-diabetics), followed by blood Group-O as: (18% in DM vs. 11% in pre-diabetics). Contrary to Group-"B" & "O", blood Group-A and Group-AB were distribution percentage higher pre-diabetic as compared to DM patients, as given as: Group-A (32% in pre-diabetics vs. 26% in DM) & Group-AB (26% in pre-diabetics vs. 24% in diabetic's patients). In addition, percentage distribution of Rh system was also calculated, in which Rh+ve Group was high and more common in DM patients as compared to pre-diabetics; numerically given as: Rh+ve Group (80% in DM vs. 72% in pre-diabetics). Different views and dimensions of the research topic were studied through literature support, some have found no any association and some established a positive association still some were not clear in making a solid conclusion. It is concluded that DM has a positive correlation with ABO blood groups, and people with Group-B have increased susceptibility to DM disease.

Resumo O objetivo principal deste estudo foi descobrir uma possível associação entre grupos sanguíneos ABO ou Rh e diabetes mellitus (DM) na população local de oito (8) diferentes cidades de Karachi, Paquistão. Para tanto, foi realizado um levantamento em Karachi para observação prática dessas cidades durante o período de 9 meses de junho de 2019 a fevereiro de 2020.De dezoito (18) cidades de Karachi, as amostras (N = 584) foram coletadas de apenas oito (8) cidades de Karachi e deram um número-código para cada cidade. A amostra do grupo de diabéticos foi (n1 = 432) e a amostra de pré-diabetes foi (n2 = 152). Um glicômetro padrão da Abbot Company para testes de açúcar no sangue aleatório (RBS) e açúcar no sangue em jejum (FBS), antissoros de sangue padrão foram usados ​​para o tipo de sangue ABO / Rh. As técnicas de avaliação de saúde foram realizadas de forma ética, tomando o consentimento informado de todos os indivíduos registrados. Finalmente, os dados foram analisados ​​pelo SPSS versão 20.0.No presente estudo, foi realizada a comparação das frequências dos grupos sanguíneos ABO entre diabéticos e pré-diabéticos. Os valores percentuais do sangue do Grupo-B são dados como: (32% em DM vs. 31% em pré-diabéticos), seguido pelo sangue do Grupo-O como: (18% em DM vs. 11% em pré-diabéticos). Ao contrário dos Grupos "B" e "O", sangue do Grupo-A e Grupo-AB tiveram distribuição percentual maior de pré-diabéticos em comparação com pacientes com DM, dado como: Grupo-A (32% em pré-diabéticos vs. 26% em DM) e Grupo AB (26% em pré-diabéticos vs. 24% em pacientes diabéticos). Além disso, também foi calculada a distribuição percentual do sistema Rh, no qual o Grupo Rh + ve foi elevado e mais comum em pacientes com DM em comparação aos pré-diabéticos; dados numericamente como: Grupo Rh + ve (80% em DM vs. 72% em pré-diabéticos). Diferentes visões e dimensões do tema de pesquisa foram estudadas com o suporte da literatura, alguns não encontraram nenhuma associação e alguns estabeleceram uma associação positiva, embora alguns não estivessem claros em fazer uma conclusão sólida. Conclui-se que o DM tem correlação positiva com os grupos sanguíneos ABO, e as pessoas com o Grupo B têm maior suscetibilidade à doença DM.

Association of blood groups/Rh and diabetes mellitus in Karachi city, Pakistan

Abstract The main purpose of this study was to find out a possible association between ABO blood groups or Rh and diabetes mellitus (DM) in the local population of eight (8) different towns of Karachi, Pakistan. For this purpose a survey was carried out in Karachi to have a practical observation of these towns during the period of 9 months from June 2019 to Feb. 2020. Out of eighteen (18) towns of Karachi, samples (N= 584) were collected from only eight (8) Towns of Karachi and gave a code-number to each town. Diabetic group sample was (n1=432) & pre-diabetes sample was (n2 =152). A standard Abbot Company Glucometer for Random Blood Sugar (RBS) and Fasting Blood Sugar (FBS) tests, standard blood anti sera were used for ABO/Rh blood type. Health assessment techniques were performed ethically by taking informed consent from all registered subjects. Finally data was analyzed by SPSS version 20.0. In our current study, the comparison of ABO blood groups frequencies between diabetic and pre-diabetic individuals were carried out. The percentage values of blood Group-B as given as: (32% in DM vs. 31% in pre-diabetics), followed by blood Group-O as: (18% in DM vs. 11% in pre-diabetics). Contrary to Group-B & O, blood Group-A and Group-AB were distribution percentage higher pre-diabetic as compared to DM patients, as given as: Group-A (32% in pre-diabetics vs. 26% in DM) & Group-AB (26% in pre-diabetics vs. 24% in diabetics patients). In addition, percentage distribution of Rh system was also calculated, in which Rh+ve Group was high and more common in DM patients as compared to pre-diabetics; numerically given as: Rh+ve Group (80% in DM vs. 72% in pre-diabetics). Different views and dimensions of the research topic were studied through literature support, some have found no any association and some established a positive association still some were not clear in making a solid conclusion. It is concluded that DM has a positive correlation with ABO blood groups, and people with Group-B have increased susceptibility to DM disease.

Resumo O objetivo principal deste estudo foi descobrir uma possível associação entre grupos sanguíneos ABO ou Rh e diabetes mellitus (DM) na população local de oito (8) diferentes cidades de Karachi, Paquistão. Para tanto, foi realizado um levantamento em Karachi para observação prática dessas cidades durante o período de 9 meses de junho de 2019 a fevereiro de 2020.De dezoito (18) cidades de Karachi, as amostras (N = 584) foram coletadas de apenas oito (8) cidades de Karachi e deram um número-código para cada cidade. A amostra do grupo de diabéticos foi (n1 = 432) e a amostra de pré-diabetes foi (n2 = 152). Um glicômetro padrão da Abbot Company para testes de açúcar no sangue aleatório (RBS) e açúcar no sangue em jejum (FBS), antissoros de sangue padrão foram usados para o tipo de sangue ABO / Rh. As técnicas de avaliação de saúde foram realizadas de forma ética, tomando o consentimento informado de todos os indivíduos registrados. Finalmente, os dados foram analisados pelo SPSS versão 20.0.No presente estudo, foi realizada a comparação das frequências dos grupos sanguíneos ABO entre diabéticos e pré-diabéticos. Os valores percentuais do sangue do Grupo-B são dados como: (32% em DM vs. 31% em pré-diabéticos), seguido pelo sangue do Grupo-O como: (18% em DM vs. 11% em pré-diabéticos). Ao contrário dos Grupos B e O, sangue do Grupo-A e Grupo-AB tiveram distribuição percentual maior de pré-diabéticos em comparação com pacientes com DM, dado como: Grupo-A (32% em pré-diabéticos vs. 26% em DM) e Grupo AB (26% em pré-diabéticos vs. 24% em pacientes diabéticos). Além disso, também foi calculada a distribuição percentual do sistema Rh, no qual o Grupo Rh + ve foi elevado e mais comum em pacientes com DM em comparação aos pré-diabéticos; dados numericamente como: Grupo Rh + ve (80% em DM vs. 72% em pré-diabéticos). Diferentes visões e dimensões do tema de pesquisa foram estudadas com o suporte da literatura, alguns não encontraram nenhuma associação e alguns estabeleceram uma associação positiva, embora alguns não estivessem claros em fazer uma conclusão sólida. Conclui-se que o DM tem correlação positiva com os grupos sanguíneos ABO, e as pessoas com o Grupo B têm maior suscetibilidade à doença DM.

Apoio social na prática de atividade física de trabalhadores / Apoyo social en la práctica de actividad física de trabajadores / Social support in workers' physical activity

Resumo Objetivo Analisar a função dos apoios sociais formal e informal na prática de atividade física durante o tempo livre de trabalhadores. Métodos Estudo transversal realizado com 395 trabalhadores técnicos administrativos em uma universidade pública. Os dados foram coletados utilizando: questionário sociodemográfico, Questionário de Atividade Física Habitual de Baecke e Escala de Apoio Social para a prática de Atividade Física. Os dados foram analisados por meio de estatística descritiva, teste t de Student, teste d de Cohen e Análise de Variância. Resultados Os participantes que referiram algum tipo de apoio para atividade física no tempo livre (92,2%) apresentaram maiores médias no escore de atividade física. O apoio institucional (58,0%) teve função de destaque como potencial influenciador em comparação ao apoio de chefias imediatas (14,2%), embora elas tenham exercido um certo diferencial entre os trabalhadores da manutenção. Conclusão O apoio social tem função importante na promoção da atividade física no tempo livre de trabalhadores. As iniciativas institucionais de estímulo ao comportamento ativo no ambiente de trabalho carecem de alinhamento com o incentivo por parte dos superiores imediatos, para que sejam mais efetivas.

Resumen Objetivo Analizar la función del apoyo social formal e informal en la práctica de actividad física durante el tiempo libre de trabajadores. Métodos Estudio transversal realizado con 395 trabajadores técnicos administrativos de una universidad pública. Los datos se recopilaron utilizando un cuestionario sociodemográfico, el Cuestionario de Actividad Física Habitual de Baecke y la Escala de Apoyo Social para la Práctica de Actividad Física. Los datos se analizaron mediante estadística descriptiva, test-T de Student, prueba d de Cohen y análisis de varianza. Resultados Los participantes que relataron algún tipo de apoyo para actividad física en el tiempo libre (92,2 %) presentaron mayores promedios en el puntaje de actividad física. El apoyo institucional (58,0 %) tuvo una función destacada como posible influenciador en comparación con el apoyo de jefes directos (14,2 %), aunque estos últimos hayan ejercido cierto diferencial entre los trabajadores de mantenimiento. Conclusión El apoyo social tiene una función importante en la promoción de la actividad física en el tiempo libre de trabajadores. Las iniciativas institucionales de estímulo a un comportamiento activo en el ambiente de trabajo necesitan estar alineadas con el incentivo por parte de los superiores inmediatos para que sean más efectivas.

Abstract Objective To analyze the role of formal and informal social support in the practice of physical activity during workers' leisure time. Methods A cross-sectional study carried out with 395 technical administrative workers at a public university. Data were collected using sociodemographic questionnaire, Baecke Habitual Physical Activity Questionnaire and Physical Activity and Social Support Scale. Data were analyzed using descriptive statistics, Student's t test, Cohen's d test and Analysis of Variance. Results Participants who reported some type of support for physical activity in their leisure time (92.2%) had higher means in the physical activity score. Institutional support (58.0%) had a prominent role as a potential influencer compared to support from immediate superiors (14.2%), although they had a certain differential among maintenance workers. Conclusion Social support plays an important role in promoting physical activity in workers' leisure time. Institutional initiatives to encourage active behavior in the work environment need to be aligned with encouragement by immediate superiors so that they are more effective.

Itinerários terapêuticos de mulheres quilombolas do norte de Minas Gerais, Brasil / Therapeutic itineraries of quilombola women in northern Minas Gerais, Brazil

Resumo Os quilombolas são grupos étnico-raciais de ancestralidade negra e tiveram seus territórios consolidados no Brasil em regiões com acesso difícil e distante dos grandes centros. O objetivo desse estudo é conhecer o itinerário terapêutico (IT) adotado por mulheres quilombolas em comunidades tradicionais localizadas no norte do estado de Minas Gerais. Trata-se de um estudo com abordagem qualitativa com o modelo teórico utilizando o sistema de cuidados à saúde de Arthur Kleinman. O estudo se deu em 23 comunidades quilombolas do norte de Minas Gerais. Foram entrevistadas 40 mulheres quilombolas, com idades entre 25 e 89 anos. A análise dos dados foi realizada seguindo os IT. Emergiram unidades de análise que foram agrupadas em três categorias: as mulheres quilombolas e o significado da saúde e do cuidado; o sistema de cuidado profissional nas comunidades quilombolas; e itinerário de cuidados nas situações vivenciadas pelas mulheres. O itinerário terapêutico das comunidades se mostra relacionado principalmente às ações de medicina popular. Foi possível observar ainda que existem fragilidades em relação à atenção à saúde devido a fatores como dificuldade de acesso aos serviços institucionalizados.

Abstract Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services.

Associação entre iniquidades raciais e condição de saúde bucal: revisão sistemática / Association between racial iniquities and oral health status: a systematic review

Resumo O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.

Abstract The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.

Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis

ABSTRACT Introduction: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes. Methods: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch. Results: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ. Conclusion: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.

Incidence of Dental Caries and Associated Factors in the School Period in a Municipality in Southern Brazil

Abstract Objective: To estimate the incidence of dental caries and associated factors in the school period from six/seven to ten years of age. Material and Methods: A longitudinal study involving 168 children was followed up between 2015 and 2019 in the municipality of Palhoça, Brazil. The dependent variable was the caries incidence rate in the mixed dentition. The independent variables included information regarding demographic and socioeconomic status. Multivariate analyzes were carried out using Poisson Regression with a robust estimator. Variables with p <0.20 in the bivariate analysis were included in the adjusted model. Relative risks were estimated, as well as 95% confidence intervals. Results: Of 168 followed schoolchildren, 32 developed the disease, providing an incidence rate of 19.0%. Female children had a 10% higher risk [RR = 1.10 (95% CI 1.03; 1.18)] of developing caries than males. Also, children born from fathers with ≤ 8 years of schooling at baseline had a 9% higher risk [RR = 1.09 (95% CI 1.01; 1.16)] of developing dental caries compared to fathers with higher education. Conclusion: The incidence of dental caries in a four-year period was 19.0%. Females and children born from fathers with a lower level of education showed higher incidence rates.

Variables tecnológicas predictoras del estrés académico en estudiantes de Enfermería en tiempos de COVID-19 / Technological variables predictors of academic stress in nursing students in times of COVID-19 / Variáveis tecnológicas preditoras do estresse acadêmico em estudantes de Enfermagem em tempos de COVID-19

Objetivo: analizar cuáles son las variables tecnológicas, derivadas del uso de dispositivo electrónico, predicen el estrés académico, y sus dimensiones en estudiantes de enfermería. Método: estudio transversal de tipo analítico, realizado en 796 estudiantes de seis universidades de Perú. Se empleó la escala SISCO y para el análisis se estimaron cuatro modelos de regresión logística, con selección de variables por pasos. Resultados: entre los participantes, 87,6% presentaron un nivel alto de estrés académico; el tiempo de uso del dispositivo electrónico, el brillo de la pantalla, la edad y el sexo, estuvieron asociados con el estrés académico y sus tres dimensiones; la posición de uso del dispositivo electrónico estuvo asociada con la escala total y con las dimensiones estresores y reacciones. Finalmente, la distancia entre el rostro y el dispositivo electrónico estuvo asociada con la escala total y la dimensión reacciones. Conclusión: las variables tecnológicas y las características sociodemográficas predicen el estrés académico en estudiantes de enfermería. Se sugiere optimizar el tiempo de uso de las computadoras, regular el brillo de la pantalla, evitar sentarse en posiciones inadecuadas y vigilar la distancia, con la finalidad de reducir el estrés académico durante la enseñanza a distancia.

Objective: to analyze which technological variables, derived from the use of electronic devices, predict academic stress and its dimensions in Nursing students. Method: analytical cross-sectional study carried out with a total of 796 students from six universities in Peru. The SISCO scale was used and four logistic regression models were estimated for the analysis, with selection of variables in stages. Results: among the participants, 87.6% had a high level of academic stress; time using the electronic device, screen brightness, age and sex were associated with academic stress and its three dimensions; the position of using the electronic device was associated with the total scale and the stressors and reactions dimensions. Finally, the distance between the face and the electronic device was associated with the total scale and size of reactions. Conclusion: technological variables and sociodemographic characteristics predict academic stress in nursing students. It is suggested to optimize the time of use of computers, regulate the brightness of the screen, avoid sitting in inappropriate positions and pay attention to the distance, in order to reduce academic stress during distance learning.

Objetivo: analisar quais variáveis tecnológicas, derivadas do uso de dispositivos eletrônicos, predizem o estresse acadêmico e suas dimensões em estudantes de enfermagem. Método: estudo transversal do tipo analítico, realizado em 796 estudantes de seis universidades do Peru. Foi utilizada a escala SISCO e foram estimados quatro modelos de regressão logística para a análise, com seleção das variáveis por etapas. Resultados: entre os participantes, 87,6% apresentaram alto nível de estresse acadêmico; o tempo de uso do aparelho eletrônico, o brilho da tela, a idade e o sexo foram associados ao estresse acadêmico e suas três dimensões; a posição de uso do aparelho eletrônico foi associada à escala total e às dimensões estressores e reações. Por fim, a distância entre o rosto e o dispositivo eletrônico foi associada à escala total e à dimensão das reações. Conclusão: variáveis tecnológicas e características sociodemográficas predizem estresse acadêmico em estudantes de Enfermagem. Sugere-se otimizar o tempo de uso dos computadores, regular o brilho da tela, evitar sentar-se em posições inadequadas e atentar-se à distância da tela, a fim de diminuir o estresse acadêmico durante o ensino a distância.

Los determinantes de la estancia hospitalaria en un hospital universitario de alta complejidad

Objetivo: Establecer y cuantificar los determinantes de la estancia hospitalaria en un hospital universitario de Medellín de alta complejidad de Medellín, entre 2013 y 2018, valorar su importancia y modelar la estancia esperada. Metodología: Estudio observacional analítico retrospectivo de datos agregados. Siguiendo el método paso a paso, se corrieron siete modelos con estancia hospitalaria media como variable dependiente y las respectivas variables independientes: complejidad, oportunidad de apoyos diagnósticos, disponibilidad de insumos, casos de estancia prolongada y capacidad financiera. Se seleccionó el mejor modelo usando los criterios de ajuste Akaike e información Bayesiana, junto con las medidas de significancia global y significancia individual de los coeficientes. Se realizaron pruebas estadísticas de validez del modelo y se calcularon los coeficientes estandarizados. Resultados: Los valores medios de las variables más relevantes y su desviación estándar (de) fueron: estancia hospitalaria media, 8,09 días (de = 0,40); complejidad por consumo de recursos, 1,28 unidades (de = 0,07); apoyos diagnósticos, 90,74 mil estudios (de = 10,05); casos de estancia extrema, 4,36 % (de = 0,70), y complejidad por casuística, 1 (de = 0,03). Significancia global F = 55,2, p< 0,001. Significancia de los coeficientes: complejidad por consumo de recursos, p< 0,01; apoyos diagnósticos y casos de estancia extrema, p< 0,001; complejidad por casuística, p< 0,05. Coeficientes estandarizados: complejidad por consumo de recursos, 0,35; apoyos diagnósticos, 0,35; casos de estancia extrema, 0,26, y complejidad por casuística, 0,24. R2 ajustado 0,82. Conclusión: Los determinantes de la estancia hospitalaria en orden de importancia son: complejidad por consumo de recursos, apoyos diagnósticos, casos de estancia extrema, complejidad por casuística, inventario disponible y ganancias brutas.

Objective: To establish and quantify the determinants of hospital stay in a high complexity university hospital in Medellin between 2013 and 2018, assess their importance, and model the expected length of stay. Methodology: Retrospective analytical observational study of aggregate data. While following the method step by step, seven models were used, where mean hospital stay was the dependent variable and the respective independent variables were complexity, timeliness of diagnostic procedures, availability of supplies, cases of prolonged stay and financial capacity. The best model was selected using the Akaike and Bayesian information criterion, along with measures of both overall significance and individual significance of the coefficients. Statistical tests of model validity were performed and standardized coefficients were calculated. Results: The mean values of the most relevant variables and their standard deviation (SD) were: mean hospital stay, 8.09 days (SD = 0.40); complexity by resource consumption, 1.28 units (SD = 0.07); diagnostic procedures, 90.74 thousand studies (SD = 10.05); cases of extremely prolonged stay, 4.36% (SD = 0.70), and complexity by casuistry, 1 (SD = 0.03). Overall significance: F = 55.2, p < 0.001. Significance of coefficients: complexity by resource consumption, p < 0.01; diagnostic procedures and cases of extremely prolonged stay, p < 0.001; complexity by casuistry, p < 0.05. Standardized coefficients: complexity by resource consumption, 0.35; diagnostic procedures, 0.35; cases of extremely prolonged stay, 0.26; and complexity by casuistry, 0.24. Adjusted R2 0.82. Conclusion: In order of importance, the determinants of hospital stay are complexity by resource consumption, diagnostic procedures, extremely prolonged stay, complexity by casuistry, available inventory and gross profit.

Objetivo: Estabelecer e quantificar os determinantes da permanência hospitalar em um hospital universitário de alta complexidade de Medellín, entre 2013 e 2018, valorar sua importância e fazer a modelação da permanência esperada. Metodologia: Estudo observacional analítico retrospectivo de dados agregados. Seguindo o método passo a passo, foram aplicados sete modelos com permanência hospitalar média como variável dependente e as respectivas variáveis independentes: complexidade, oportunidade de apoios diagnósticos, disponibilidade de insumos, casos de permanência prolongada e capacidade financeira. Selecionou-se o melhor modelo usando os critérios de ajuste Akaike e informação Bayesiana, junto com as medidas de significância individual dos coeficientes. Realizaram-se provas estatísticas de validade do modelo e calcularam-se os coeficientes padronizados. Resultados: Os valores médios das variáveis mais relevantes e seu desvio-padrão (DP) foram: permanência hospitalar média, 8.09 dias (DP = 0,40); complexidade por consumo de recursos, 1,28 unidades (DP = 0,07); apoios diagnósticos, 90,74 mil estudos (DP = 10,05); casos de permanência extrema, 4,36 % (DP = 0,70), e complexidade por casuística, 1 (DP = 0,03). Significância global F = 55,2, p < 0,001. Significância dos coeficientes: complexidade por consumo de recursos, p < 0,01; apoios diagnósticos e casos de permanência extrema p < 0,001; complexidade por casuística, p < 0,05. Coeficientes padronizados: complexidade por consumo de recursos, 0,35; apoios diagnósticos, 0,35; casos de permanência extrema, 0,26 e complexidade por casuística, 0,24. R2 ajustado 0,82. Conclusão: Os determinantes da permanência hospitalar em ordem de importância são: complexidade por consumo de recursos, apoios diagnósticos, casos de permanência extrema, complexidade por casuística, inventário disponível e lucros brutos.

A experiência de atendimento de um grupo terapêutico durante a graduação: a obstaculização pelo pacto denegativo / La experiencia de asistir a un grupo terapéutico durante la graduación: el obstáculo causado por el pacto negativo / The experience of attending a therapeutic group during graduation: the obstacle caused by the negative pact

Grupos psicoterapêuticos encontram crescente receptividade nos serviços públicos e privados de saúde. Eles conjugam a expansão da capacidade de atendimento com atuação clínica crítica e propositiva frente ao individualismo da sociedade contemporânea. É importante assim pensarmos os desafios da formação dos psicólogos para este trabalho. Este artigo parte de uma dificuldade encontrada por estagiários de 4° e 5° ano do curso de psicologia, na condução de um grupo psicoterapêutico. Coloca-se como objetivo analisar a relação entre um pacto denegativo que obstaculiza o processo terapêutico com as experiências iniciais de atendimento dos estagiários. Aspectos vivenciados serão apresentados e debatidos à luz da teoria. Descreve-se a existência de um pacto denegativo neste grupo, que se opõe ao processo terapêutico dos pacientes e complexifica o desenvolvimento dos estagiários ao desafiar a confiança em suas percepções e associações, dificultando a realização de intervenções. Conclui-se que o pacto denegativo que obstaculiza o grupo se apresenta, a princípio, como um desafio aos estagiários, porém, mediante o apoio na relação entre os estagiários e supervisão é possível transformar este desafio em fonte de aprendizado.

Grupos psicoterapéuticos son cada vez más recibidos en los servicios de salud. Combinan la expansión de la capacidad de servicio con una acción clínica crítica y decidida frente al individualismo de la sociedad contemporánea. Es importante pensar en los desafíos de formar psicólogos para este trabajo. Este artículo se basa en una dificultad que enfrentan los pasantes de 4° y 5° año de psicología al momento de conducir un grupo psicoterapéutico. El objetivo es analizar la relación entre un pacto negativo que obstruye el proceso terapéutico y las experiencias de cuidado de los internos. Se debatirán experiencias y la teoría. Se describe la existencia de un pacto negativo, que se opone al proceso terapéutico de los pacientes e intensifica el desafío de los alumnos al desafiar la confianza en sus percepciones y asociaciones, lo que dificulta la realización de intervenciones. Se concluye que el pacto negativo que obstaculiza al grupo se presenta, en un primer momento, como un reto para los aprendices, sin embargo, a través del apoyo en la relación entre los aprendices y la supervisión es posible transformar este reto en una fuente de aprendizaje.

Psychotherapeutic groups are increasingly employed in health services. They combine the expansion of the service capacity with critical and purposeful clinical action in face of the individualism of contemporary society. It is important to think about the challenges of training psychologists for this work. This article is based on a difficulty encountered by 4th and 5th year psychology students, acting as trainees, when conducting a psychotherapeutic group. The objective is to analyze the relationship between a denegative pact that obstructs the therapeutic process and the trainees' initial clinical experience. This text debates aspects of this practice in light of theory. It describes a denegative pact in this group, which opposes the patients' therapeutic process and intensifies the trainees' challenge by challenging the trust in their perceptions and associations, making it more difficult for them to find spaces to intervene. It concludes that the negative pact that hinders the group presents itself, in principle, as a challenge to the trainees, however, through support in the relationship between the trainees and supervision it is possible to transform this challenge into a source of learning.

Autoestima de trabalhadores terceirizados do setor de conservação de higiene e limpeza de hospitais privados / Self-esteem of outsourced workers in the hygiene conservation and cleaning of private hospitals / Autoestima de trabajadores subcontratados en el sector de higiene y limpieza de hospitales privados

Objetivo: analisar aspectos positivos e negativos relacionados à autoestima de trabalhadores terceirizados de serviços de higiene e limpeza hospitalar. Método: estudo exploratório, de abordagem qualitativa, realizado em duas instituições hospitalares privadas. Os participantes foram trabalhadores terceirizados dos serviços de higiene e limpeza. Para a coleta de dados, utilizou-se um questionáriosociodemográfico e um roteiro de entrevista semiestruturada. Realizada análise temática indutiva. Resultados: a amostra constitui-se de 15 trabalhadores, do sexo feminino, que expressaram aspectos positivos e negativos que afetam sua autoestima, que estão relacionados à organização e ambiente de trabalho, às relações interpessoais e benefícios trabalhistas. Conclusão: aspectos positivos e negativos estão presentes entre esses trabalhadores e os gestores hospitalares devem refletir sobre o serviço de higiene e limpeza, estabelecendo estratégias educativas e coletivas para os trabalhadores relacionadas às práticas de trabalho realizadas neste contexto.

Objective: to analyze positive and negative aspects related to the self-esteem of outsourced workers in hospital hygiene and cleaning services. Method: exploratory study, with a qualitative approach, carried out in two private hospital institutions. Participants were outsourced workers from hygiene and cleaning services. For data collection, a sociodemographic questionnaire and a semi-structured interview script were used. Inductive thematic analysis was performed. Results: the sample consisted of 15 female workers, who expressed positive and negative aspects that affect their self-esteem, which are related to the organization and work environment, interpersonal relationships and work benefits. Conclusion: positive and negative aspects are present among these workers and hospital managers should reflect on the hygiene and cleaning service, establishing educational and collective strategies for workers related to work practices carried out in this context.

Objetivo: analizar aspectos positivos y negativos relacionados con la autoestima de trabajadores subcontratados en los servicios de higiene y limpieza hospitalaria. Método: estudio exploratorio, con enfoque cualitativo, realizado en dos hospitales privadas. Los participantes eran trabajadores subcontratados de los servicios de higiene y limpieza. Para la recolección de datos, se utilizó un cuestionario sociodemográfico y un guion de entrevista semiestructurada. Se realizó un análisis temático inductivo. Resultados: la muestra estuvo conformada por 15 trabajadoras, quienes expresaron aspectos positivos y negativos que inciden en su autoestima, los cuales están relacionados con la organización y clima laboral, las relaciones interpersonales y las prestaciones laborales. Conclusión: los aspectos positivos y negativos están presentes entre estos trabajadores y los administradores de hospitales deben reflexionar sobre el servicio de higiene y limpieza, estableciendo estrategias educativas y colectivas para los trabajadores, relacionadas con las prácticas de trabajo realizadas en este contexto.

¿Cómo construir un Cuerpo Académico... y tener éxito? / How to integrate an Academic Group... and be successful?

Introducción: para las universidades públicas, uno de los indicadores fundamentales es consolidar los grupos de investigación en Cuerpos Académicos (CA). Sin embargo, no existe una guía que apoye la transición. El propósito es exponer algunas recomendaciones para conformar un CA con éxito, con base en las experiencias de trabajo del Cuerpo Académico Intervenciones para el Cuidado de la Salud. Desarrollo: los CA están conformados por docentes-investigadores de tiempo completo que comparten y desarrollan una línea de investigación en temas disciplinares o multidisciplinares, enfocados en objetivos académicos comunes. La reflexión que plantea este manuscrito contribuye a identificar las fortalezas y áreas de oportunidad de los grupos de investigación, así mismo se describen algunas estrategias para transitar y consolidar un CA: 1. Selección de los integrantes, 2. Línea de investigación, 3. Proyectos, 4. Servicio a la sociedad, 5. Trabajo colegiado, 6. Redes de investigación, 7. Integración de estudiantes y 8. Liderazgo transformacional. Conclusión: la creación de CA es fundamental en el desarrollo de las instituciones de educación superior en México, para alcanzar este reto es necesario integrar estrategias innovador... (AU)

Abstract Introduction: For public universities, a fundamental indicator is to consolidate research groups in Academic Bodies (AB). However, there is no guide to support the transition. Purpose: to present some recommendations to form AB successfully based on the work experiences of the Academic Body Interventions for Health Care. Development: The academic bodies are made up of full-time professors-researchers who share and develop a line of research on disciplinary or multidisciplinary topics and which entail a set of common academic objectives and goals. The reflection proposed by this manuscript contributes to identifying the strengths and areas of opportunity of the research groups, as well as describing some strategies to consolidate as an academic body: 1. The selection of the members, 2. The line of research, 3. Projects, 4. Service to society, 5. Collegiate work, 6. Research networks, 7. Integration of students and 8. Transformational leadership. Conclusion: Creating Academic Bodies is essential in the development of higher education institutions in Mexico, to meet this challenge it is necessary to integrate innovative strategies to generate and disseminate knowledge and the disposition of the members for collegiate work.

O anti-grupo como fenómeno. Reflexão sobre as resistências nos grupos comunitários de articulação (inter)institucional / The antigoup as a phenomenon. Reflection on the resistance in community groups of (inter)institutional articulation / El antigrupo como fenómeno. Reflexión sobre la resistencia en grupos comunitarios de articulación (inter)institucional

Objetivo: Com esta reflexão a autora pretende contribuir para uma maior compreensão dos fenómenos grupais presentes no trabalho de articulação (inter)institucional dos vários profissionais que intervêm na área da saúde mental comunitária. Metodologia: Partindo da sua experiência a autora reflete sobre as múltiplas formas de resistência que podemos encontrar nos grupos de profissionais que intervêm na área da saúde mental comunitária, nomeadamente as resistências que diretamente se manifestam na articulação de âmbito interinstitucional entre profissionais relacionando, de entre outros, o conceito de anti-grupo, cunhado por Morris Nitsun, com os entraves ao funcionamento destes grupos (inter)institucionais. Resultados: São identificados os fenómenos agressivos e destrutivos que se podem constituir como resistências e proposta a sua origem nos mecanismos psíquicos como a transferência, clivagens, deslocamentos, projeções e identificações projetivas. Conclusões: O pensamento e compreensão grupanalítica do funcionamento dos grupos de trabalho é fundamental para que o potencial agressivo e destrutivo dos grupos não seja desvalorizado, ignorado ou estimulado, contribuindo para o seu sucesso.

Objective: With this reflection, the author intends to contribute to a greater understanding of the group phenomena present in the work of inter-institutional articulation in the field of community mental health. Metodology: Based on her experience, the author reflects on the multiple forms of resistance that we can find in groups of professionals who intervene in the area of community mental health, namely the resistance that directly manifests itself in the inter-institutional articulation between professionals relating, among others, the anti-group concept, coined by Morris Nitsun, with the obstacles to the functioning of these inter-institutional groups. Results: Aggressive and destructive phenomena that can constitute resistances are identified and their origin is proposed in internal mechanisms such as transference, cleavages, projections and projective identifications. Conclusions: A groupanalytic thinking and understanding of the functioning of inter-institutional work groups is essencial so that the aggressive and destructive potential of groups is not devalued, ignored or stimulated, contributing to their success.

Objetivo: Con esta reflexión, el autor pretende contribuir a una mayor comprensión de los fenómenos grupales presentes en el trabajo de articulación interinstitucional en el campo de la salud mental comunitaria. Metodología: A partir de su experiencia, la autora reflexiona sobre las múltiples formas de resistencia que podemos encontrar en los grupos de profesionales que intervienen en el área de la salud mental comunitaria, a saber, la resistencia que se manifiesta directamente en la articulación interinstitucional entre profesionales que se relacionan, entre otros, el concepto de antigrupo, acuñado por Morris Nitsun, con los obstáculos para el funcionamiento de estos grupos interinstitucionales. Resultados: Se identifican fenómenos agressivos y destructivos que pueden constituir resistência y se propone su origen en mecanismos psíquicos como la transferência, escisiones, desplazamientos, proyecciones y identificaciones proyectivas. Conclusiones: El pensamiento grupoanalítico y la comprensión del funcionamento de los grupos de trabajo es fundamental para que el potencial agressivo y destructivo de los grupos no sea devaluado, ignorado o estimulado, contribuyendo a su éxito.