Attitudes of the Portuguese population towards advance directives: an online survey.

BACKGROUND: Advance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender/marital status/religion/level of education/residence/whether they were a health professional/whether they had already drawn up a living will) and people's attitudes towards ADs. METHODS: An online cross-sectional analytical study was conducted using a convenience sample. For this purpose, a request (email) that publicized the link to a -form-which included sociodemographic data and the General Public Attitudes Toward Advance Care Directives (GPATACD) scale-was sent to 28 higher education institutions and 30 senior universities, covering all of mainland Portugal and the islands (Azores and Madeira). The data were collected between January and February 2023. RESULTS: A total of 950 adults from completed the online form. The lower scores (mean 1 and 2) obtained in most responses by applying the GPATACD scale show that the sample of the Portuguese population has a very positive attitude towards ADs. The data showed that women, agnostics/atheists, health professionals and those who had already made a living will had more positive attitudes (p < 0.001) towards ADs. There were no statistically significant differences in the attitudes of the Portuguese population sample towards ADs in relation to marital status, education level, and residence. CONCLUSION: The results obtained enable us to confirm that this sample of the Portuguese population has a positive attitude towards ADs. We verify that there are certain fringes of this sample with certain sociodemographic characteristics (women, agnostics/atheists, health professionals and those who had already made a living will) that have a more positive attitude towards ADs. This data could facilitate the implementation and adjustment of relevant measures, particularly in the field of health education and aimed at groups with less favourable attitudes, to increase the effectiveness of voluntary exercise of citizens' autonomy in end-of-life care planning.

Sternal cleft: new options for reconstruction.

Sternal cleft (SC) is a rare congenital affection caused by the absence of sternal bar union. Diagnosis is generally made after birth due to paradoxical midline movement, although it can be made prenatally by ultrasonography. A computerized tomography scan (CT scan) after birth is generally used to confirm the diagnosis, assess other intrathoracic conditions, classify the SC, and plan for surgery. SC can be classified as complete or incomplete. A complete SC has a full gap between sternal bars. An incomplete SC is subdivided into superior or inferior, related to the point of bone fusion between the sternal bars. The goal of surgical treatment is to protect mediastinal structures. Many authors advocate the repair in newborn patients, although it can be performed in older patients. The main argument in its favor is the chest's flexibility, with a reduced risk of compression of the mediastinal structures. There are several cases of series and distinct surgical techniques in the literature. Some authors have suggested the use of autologous tissue, prosthetic material such as mesh, or titanium plates and screws. Although difficulties are often encountered in surgical access, they have not been discussed. Therefore, we are promoting modifications to the technique in response to this. The purpose is to show innovations, and how to deal with adversity during the procedure.

The use of social simulation modelling to understand adherence to diabetic retinopathy screening programs.

The success of screening programs depends to a large extent on the adherence of the target population, so it is therefore of fundamental importance to develop computer simulation models that make it possible to understand the factors that correlate with this adherence, as well as to identify population groups with low adherence to define public health strategies that promote behavioral change. Our aim is to demonstrate that it is possible to simulate screening adherence behavior using computer simulations. Three versions of an agent-based model are presented using different methods to determine the agent's individual decision to adhere to screening: (a) logistic regression; (b) fuzzy logic components and (c) a combination of the previous. All versions were based on real data from 271,867 calls for diabetic retinopathy screening. The results obtained are statistically very close to the real ones, which allows us to conclude that despite having a high degree of abstraction from the real data, the simulations are very valid and useful as a tool to support decisions in health planning, while evaluating multiple scenarios and accounting for emergent behavior.

Acute venous thromboembolism plasma and red blood cell metabolomic profiling reveals potential new early diagnostic biomarkers: observational clinical study.

BACKGROUND: Venous thromboembolism (VTE) is a leading cause of cardiovascular mortality. The diagnosis of acute VTE is based on complex imaging exams due to the lack of biomarkers. Recent multi-omics based research has contributed to the development of novel biomarkers in cardiovascular diseases. Our aim was to determine whether patients with acute VTE have differences in the metabolomic profile compared to non-acute VTE. METHODS: This observational trial included 62 patients with clinical suspicion of acute deep vein thrombosis or pulmonary embolism, admitted to the emergency room. There were 50 patients diagnosed with acute VTE and 12 with non-acute VTE conditions and no significant differences were found between the two groups for clinical and demographic characteristics. Metabolomics assays identified and quantified a final number of 91 metabolites in plasma and 55 metabolites in red blood cells (RBCs). Plasma from acute VTE patients expressed tendency to a specific metabolomic signature, with univariate analyses revealing 23 significantly different molecules between acute VTE patients and controls (p < 0.05). The most relevant metabolic pathway with the strongest impact on the acute VTE phenotype was D-glutamine and D-glutamate (p = 0.001, false discovery rate = 0.06). RBCs revealed a specific metabolomic signature in patients with a confirmed diagnosis of DVT or PE that distinguished them from other acutely diseased patients, represented by 20 significantly higher metabolites and four lower metabolites. Three of those metabolites revealed high performant ROC curves, including adenosine 3',5'-diphosphate (AUC 0.983), glutathione (AUC 0.923), and adenine (AUC 0.91). Overall, the metabolic pathway most impacting to the differences observed in the RBCs was the purine metabolism (p = 0.000354, false discovery rate = 0.68). CONCLUSIONS: Our findings show that metabolite differences exist between acute VTE and nonacute VTE patients admitted to the ER in the early phases. Three potential biomarkers obtained from RBCs showed high performance for acute VTE diagnosis. Further studies should investigate accessible laboratory methods for the future daily practice usefulness of these metabolites for the early diagnosis of acute VTE in the ER.

Advance Directives in Portugal: A Qualitative Survey.

(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted-eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives.

Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review.

(1) Background: Advance directives are an expression of a person's autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalised is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population's perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: "advance care directives", "advance care planning", "perceptions", "attitudes", and "knowledge". Two hundred and twenty-four (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures.

Mulheres de Bairros Populares em Caxias-MA: Vidas que (Re)Existem / Women From Low-Income Neighborhoods in Caxias-MA: Lives that Exist / Mujeres de Barrios Populares de Caxias-MA: Vidas que (Re) Existen

O presente estudo parte das experiências das mulheres nos bairros populares de uma cidade do interior do Maranhão, Caxias. Objetivou-se conhecer as histórias de vida das mulheres desses bairros, os seus modos de vida e resistência em suas vivencias diárias. Trata-se de uma pesquisa qualitativa que tem como base a produção de sentido no cotidiano. Participaram cinco mulheres de quatro bairros populares do município. Foram utilizadas a observação no cotidiano, conversas no cotidiano e entrevista semiestruturada. Para a análise foi utilizado o mapa dialógico de produção de sentidos. Percebeu-se que as mulheres atuam enquanto sujeitas ativas em seus bairros buscando por melhores condições de vida, em prol de educação e infraestrutura, a partir da formação de uma rede de sociabilidade e solidariedade, à frente de clube de mães, associação de moradores e grupo de dança enquanto formas de resistência. Logo, entende-se que esse estudo pode contribuir com a literatura e discussões sobre mulheres de contextos periféricos de regiões não metropolitanas.

The present study is based on the experiences of women from the low-income neighborhoods of Caxias, a country town in the Brazilian State of Maranhão. The purpose was to investigate the life stories of women who live in that neighborhoods, their ways of life, and resistance in their daily experiences. This is a qualitative research that is based on the production of meaning in everyday life. We have researched five women from four low-income neighborhoods in the city through daily observation, daily conversations, and semi-structured interviews. We have used the dialogic map of production of meaning for this analysis. It was noticed that women act as active subjects in their neighborhoods, looking for better living conditions towards education and infrastructure. They do it building a network of sociability and solidarity which includes a front of mothers' club, community association, and dance group as forms of resistance. Therefore, we realize that this study can contribute to the literature and to the discussion about women from peripheral contexts of non-metropolitan regions.

El presente estudio se basa en las experiencias de mujeres en los barrios populares de una ciudad del interior de Maranhão, Caxias. El objetivo fue conocer las historias de vida de mujeres que viven en barrios populares de Caxias do Maranhão, sus formas de vida y resistencia en sus experiencias cotidianas. Se trata de una investigación cualitativa que se fundamenta en la producción de sentido en la vida cotidiana. Participaron cinco mujeres de cuatro barrios populares de la ciudad. Se utilizó la observación diaria, conversaciones diarias y entrevistas semiestructuradas. Para el análisis se utilizó el mapa dialógico de producción de sentido. Se percibió que las mujeres actúan como sujetos activos en sus barrios buscando mejores condiciones de vida, a favor de la educación e infraestructura, a partir de la formación de una red de sociabilidad y solidaridad, al frente del club de madres, asociación de vecinos y grupo de baile como formas de resistencia. Por lo tanto, se entiende que este estudio puede contribuir a la literatura y discusiones sobre mujeres de contextos periféricos de regiones no metropolitanas.

O plano de parto como mecanismo de proteção do direito à autodeterminação da mulher em contexto obstétrico em Portugal / El pla de part com a mecanisme de protecció el dret a l'autodeterminació de la dona en context obstètric a Portugal / El plan de parto como mecanismo de proteccion el derecho a la autodeterminación de la mujer en contexto obstétrico en Portugal / The birth plan as a safeguard mechanism the right to self-determination of women in obstetric context in Portugal

A violência obstétrica constitui uma das formas de violência contra a mulhere seusdireitosà saúde, segurança, integridade físicaepsíquica, e, nos casos mais extremos, o direito à própria vida. Abordaremosa violência ocorrida no parto, através de insultos, falta de informação, desrespeito pela autonomia e autodeterminação da mulher e da violação do consentimento informado. A prática de procedimentos médicos como a episiotomia, excesso de medicação, privação de movimentos, manobras de Kristeller,entre outras, são potenciadoras de risco para a saúde e vida do próprio feto/criança. Afirmamos que a violência obstétrica é, em muitos casos, não apenas uma violência contra a mulher, mas também contra a criança. Os casos em que a criança venha a nascer com malformações ou doenças resultantes dos maus-tratos que a mãe sofreu no parto, geram responsabilidade médica. Recorremosa obras e a estudos na área do Direito, Bioética e Saúde Reprodutiva assim como, procedemos à análise exaustiva de diplomas legais internacionais e nacionais. Concluímos que a violência exercida contra a mulher no contexto obstétrico atenta frontalmente contra as leges artis medicinaee constitui uma forma de discriminação de género severa que merece censura legal por parte dosEstados e por parte da própria classe médica. Afirmamosque a episiotomia é atualmente qualificada como uma espécie de mutilação genital feminina, criminalmente punível. Defendemos que o direito a acompanhamento no parto e ao cumprimento do plano de parto elaborado pela mulher ou casal são dois mecanismos essenciais a atenuar ou a eliminar a violência obstétrica.(AU)

La violencia obstétrica es una formade violencia contra las mujeres, vulnerando derechoscomo la salud, seguridad, integridad físicaypsicológica, y, en los casos más extremos, el derecho a la vida.Abordaremos la violencia que se produce en el partoa través de insultos, falta de información, falta de respeto a la autonomía y autodeterminación de la mujer y violación del consentimiento informado. La práctica de procedimientos médicos como la episiotomía, medicación excesiva, privación de movimiento, maniobras de Kristeller, entre otros, son factores potenciales de riesgo para la salud y la vida del feto/niño. Afirmamos que la violencia obstétrica es, en muchos casos, no sólo violencia contra la mujer, sino también contra el niño. Los casos en que el niño nace con malformaciones o enfermedades resultantes del maltrato que la madre sufrió en el parto, generan responsabilidad médica. Recurrimos a trabajos en el área del Derecho, la Bioética y la Salud Reproductivay textos jurídicos internacionales y nacionales. Concluimos que este tipo deviolencia contra la mujer atenta directamente contra las leges artis medicinaey constituye una forma de grave discriminación de género que merece la censura jurídica de los Estados y de la propia profesión médica. Afirmamos que la episiotomía está calificada actualmente como un tipo de mutilación genital femenina, sancionable penalmente. Sostenemos que el derecho a estar acompañada durante el parto y a cumplir con el plan de parto elaborado por la mujer o la pareja son dos mecanismos esenciales para mitigar o eliminar la violencia obstétrica.(AU)

Obstetric violence is a form of violence against women, infringingrights such as health, safety, physical and psychological integrity, and, in the most extreme cases, the right to life. We will address violence during childbirth through insults, lack of information, lack of respect for women's autonomy and self-determination, and violation of informed consent. The practice of medical procedures such as episiotomy, excessive medication, deprivation of movement, Kristeller maneuvers, among others, are potential risk factors forthe health and life of the fetus/child. We affirm that obstetric violence is, in many cases, not only violence against the woman, but also against the child. Cases in which the child is born with malformations or diseases resulting from the mistreatment suffered by the mother during childbirth, generate medical responsibility. We refer to works in the area of Law, Bioethics and Reproductive Health and international and national legal texts. We conclude that this type of violence against women is a direct violation of leges artis medicinaeand constitutes a form of serious gender discrimination that deserves legal censure by States and the medical profession itself. We affirm that episiotomy is currently classified as a type of female genital mutilation, punishable under criminal law. We maintain that the rightto be accompanied during childbirth and to comply with the birth plan drawn up by the woman or partner are two essential mechanisms for mitigating or eliminating obstetric violence.(AU)

Vocal Impact in Patients With Unilateral Diaphragmatic Paralysis.

OBJECTIVES: This study aimed to investigate the possible vocal impact confirmed by diagnostic tests, the degree of perception of possible vocal impairment by patients with Unilateral Diaphragmatic paralysis (UDP) and its correlation with ventilatory weakness. METHODS: The researchers conducted an analytical, observational and case-control study with 70 individuals, including 35 UDP patients and 35 healthy patients in a control group, who underwent the following assessments: 1) Self-assessment of voice handicap (VHI-10); 2) Self-Assessment of Quality of Life (SF-36); 3) Self-Assessment of Dyspnea (MRC); 4) Objective vocal measures (Maximum Phonation Time (MPT) in /a/, /s/, /z/ and glottal-to-noise excitation ratio); 5) Functional respiratory pressures (Spirometry and maximum ventilatory pressures); 6) General degree of dysphonia - G on the GRBAS Scale. The sex, age and body mass index (BMI) of the individuals were the variables used to match the sample of this study. RESULTS: When compared with controls, patients with UDP had a restrictive functional pattern and inspiratory weakness, with symptoms of dyspnea and worsening quality of life. When associated with a possible vocal impact, these patients had voice handicap and decreased MPT values for all phonemes, especially /a/. There was also a correlation between vocal performance and inspiratory weakness. However, it should be noted that, despite having vocal impairment, many patients did not report the perception of this fact, somehow neglecting such impairment. CONCLUSIONS: In addition to the expected weakness of the ventilatory muscles, patients with UDP had clinically verified vocal impact, and those who had greater inspiratory weakness also had greater voice impairment. Finally, it is relevant that not all patients perceived such vocal impact, which showed a very reduced perception of this impairment in patients with UDP.

Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff.

OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.

Políticas desenvolvimentistas e mulheres quebradeiras de coco babaçu: capturas contemporâneas / Developmentalist policies and babassu coconut-breaking women: contemporary catches / Políticas desarrollistas y las mujeres que rompen coco babaçu: capturas contemporáneas

Este estudo propõe analisar as relações e os processos de subjetivação de mulheres quebradeiras de coco babaçu decorrentes das intervenções de políticas desenvolvimentistas em seus territórios de vida e reverberações no Movimento Interestadual de Quebradeiras de Coco Babaçu (MIQCB). Sob a perspectiva ético-estético-política da Cartografia, acompanhamos as narrativas das histórias de vida de 24 mulheres, suas atividades cotidianas e eventos do MIQCB, também analisamos os documentos das políticas. Entendemos que, ao passo que tais políticas de desenvolvimento rural contribuem para a melhoria das condições de vida, em termos materiais e simbólicos, elas também produzem ressonâncias relacionadas ao modo de subjetivação do tipo "empresário de si", que agenciam seus modos de viver, de produzir e de se relacionar consigo e com os outros na lógica capitalista neoliberal. A resistência às capturas neoliberais também estão presentes ao ampliarem as mobilizações coletivas do próprio movimento, articulando com outros na produção de um "comum".(AU)

This study proposes to analyze the relations and the processes of subjectivation of babassu coconut-breaker women arising from developmental policy interventions in their territories of life and reverberations in the Babassu Coconut-breaker Interstate Movement (MIQCB). From the ethical-aesthetic-political perspective of Cartography, we followed the narratives of the life stories of 24 women, their daily activities and promoted events by MIQCB, we also analyzed the policy documents. We understand that while these policies of rural development contribute to improve the living conditions, in material and symbolic terms, they also produce resonances related to the "self-entrepreneur" mode of subjectivation, which has been handling their ways of living, producing, and relating to themselves and others in the neoliberal capitalist logic. Resistance to neoliberal captures is also present as they expand the collective mobilizations of the movement itself, articulating with others, in the production of a "common."(AU)

Este estudio tiene como objetivo analizar los procesos de subjetivación de las mujeres que rompen coco babaçu que surgen de las intervenciones de las políticas de desarrollo en sus territorios de vida y las reverberaciones en el Movimiento Interestadual de las Mujeres que Rompen Coco Babaçu (MIQCB). Desde la perspectiva ético-estético-política de la Cartografía, seguimos las narraciones de las historias de vida de 24 mujeres, sus actividades diarias y eventos del MIQCB, y también analizamos los documentos de las políticas. Si bien estas políticas han contribuido a mejorar las condiciones de vida de las mujeres, en términos materiales y simbólicos, también han producido resonancias del modo de subjetivación "autoempresarial", que ha agenciado sus formas de vivir, producir y relacionarse consigo mismas y con los demás en la lógica capitalista neoliberal. La resistencia a las capturas neoliberales también está presente cuando amplían las movilizaciones colectivas del propio movimiento, articulándose con otros en la producción de un "común".(AU)

Encarceramento feminino: um debate entre criminologia e perspectivas feministas / Female incarceration: a debate between criminology and feminist perspectives / Encarcelamiento femenino: un debate entre la criminología y las perspectivas feministas

Este ensaio teórico-reflexivo tem como objetivo discutir sobre as contribuições dos estudos da criminologia e sua crítica para as diversas formas de aprisionamento feminino, e mais atualmente para o encarceramento em massa no sistema prisional, além de abrir espaço para o debate sobre as diferentes perspectivas feministas e as relações com os estudos criminológicos, sobretudo com os posicionamentos da chamada criminologia crítica. Reconhecem-se importantes avanços e conquistas feministas no debate sobre a estruturação masculinizada do direito penal e do seu fazer jurídico, mas também a manutenção de diversas formas de violência de gênero que configuram um sistema penal antropocêntrico, seletivo, racista e discriminatório. Indica-se a urgência de estudos interseccionais que considerem as particularidades e reinvindicações das mulheres no cárcere e suas formas de militância, sobretudo diante de população carcerária feminina composta majoritariamente por mulheres negras, pobres e periféricas. Faz-se visível a necessidade de uma análise dos fatores que atravessam o encarceramento feminino por uma ótica feminista plural, adequada às realidades que se estudam e atenta às múltiplas perspectivas que podem existir dentro do feminismo.(AU)

This theoretical-reflexive essay aims to discuss the contributions of criminological studies and their critique of the various forms of imprisonment of women, and more recently of mass incarceration in the prison system, in addition to opening space for the debate on the different feminist perspectives and their relations with criminological studies, especially with the positions of the so-called critical criminology. Important feminist advances and conquests are recognized in the debate about the masculinized structure of penal law and its legal practice, but also the maintenance of diverse forms of gender violence that configure an anthropocentric, selective, racist, and discriminatory penal system. It indicates the urgency of intersectional studies that consider the particularities and claims of women in prison and their forms of militancy, especially in the face of the female prison population composed mostly of black, poor, and peripheral women. The need for an analysis of the factors that cross women's imprisonment from a plural feminist perspective, adequate to the realities under study and attentive to the multiple perspectives that may exist within feminism, becomes visible.(AU)

Este ensayo teórico-reflexivo pretende discutir las aportaciones de los estudios criminológicos y su crítica a las distintas formas de encarcelamiento femenino, y más recientemente de encarcelamiento masivo en el sistema penitenciario, además de generar debate sobre las distintas perspectivas feministas y sus relaciones con los estudios criminológicos, especialmente con las posiciones de la Criminología Crítica. Se reconocen importantes avances y logros feministas en el debate sobre la estructuración masculinizada del derecho penal y su práctica jurídica, además del mantenimiento de diversas formas de violencia de género que configuran un sistema penal antropocéntrico, selectivo, racista y discriminatorio. Se necesitan estudios interseccionales que consideren las particularidades y reivindicaciones de las mujeres en prisión y sus formas de militancia, principalmente ante la población penitenciaria femenina compuesta mayoritariamente por mujeres negras, pobres y periféricas. Se hace evidente la necesidad de analizar los factores que inciden en el encarcelamiento femenino desde una perspectiva feminista plural, adecuada a las realidades que se estudian y atenta a las múltiples perspectivas que pueden existir dentro del feminismo.(AU)

Capacidade de resposta do NASF em saúde mental / NASF responsiveness in mental health

Resumo Objetivou-se analisar a capacidade de resposta do Núcleo de Apoio à Saúde da Família (NASF) em saúde mental em três estados nordestinos a partir do II e III Ciclos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Os resultados foram analisados em nível estadual, nos municípios pertencentes ao G1 e nos 48 municípios que concentram simultaneamente assentamentos rurais e comunidades quilombolas. Identificaram-se aspectos mais e menos favoráveis em termos da oferta de ações em saúde mental que atravessam os dois ciclos avaliativos. Os dados demonstram a possibilidade de um efetivo compartilhamento de responsabilidades e de coordenação do cuidado entre o NASF e as equipes de AB. Entretanto, em relação às demandas de cuidado referentes ao uso de substâncias psicoativas, em ambas as avaliações e nos três níveis de estratificação, as equipes NASF obtiveram desempenho menos favorável, indicando que a capacidade de resposta ao sofrimento associado ao uso de álcool e outras drogas é menos efetiva, precisando ser reforçada e aprimorada na APS.

Abstract The article aimed to analyze the responsiveness of the Family Health Support Center (NASF) in mental health in three northeastern states from the II and III Cycles of National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The results were analyzed at the state level, in the municipalities belonging to G1 and in the 48 municipalities that concentrate both rural settlements and quilombola communities. We identified more and less favorable aspects in terms of the offer of mental health actions across the two evaluation cycles. The data show the possibility of an effective sharing of responsibilities and care coordination between NASF and the Primary Health Care (PHC) teams. However, regarding the demands of care related to the use of psychoactive substances, in both evaluations and in the three levels of stratification, the NASF teams performed less favorably, indicating that the response capacity to the suffering associated with the use of alcohol and other drugs is less effective, needing to be strengthened and improved in PHC.

Produções literárias e audiovisuais nas periferias de Fortaleza: (re)inventando territórios de infâncias e juventudes periféricas / Literary and audiovisual productions on the peripheries of Fortaleza: (re)inventing peripheral childhood and youth territo

Este artigo tem como objetivo discutir a reinvenção de territórios das infâncias e juventudes periféricas a partir de fotografias e poemas produzidos pelo fotógrafo Leo Silva e pelo poeta Talles Azigon (identificados após a aprovação do artigo) como modo de re-existência em Fortaleza. São problematizações advindas da realização de uma pesquisa-inter(in)venção de ethos cartográfico, junto a esses jovens, em que as imagens e os poemas emergem como dispositivos lúdicos na produção de movimentos contra-hegemônicos frente às "imagens oficiais" historicamente impostas sobre as periferias. Por meio dessas fotografias e poemas, e, portanto, da arte, a reivindicação dos territórios retrata e narra infâncias e juventudes de periferias de Fortaleza a partir de suas potências e não de suas precarizações. Como experimentação, o artigo foi produzido a partir desses poemas e fotografias, além de contar com as participações de (a ser identificado, caso o artigo seja aceito, pois atua como participante da escrita do artigo) e (a ser identificado, caso o artigo seja aceito, pois atua como participante da escrita do artigo) na elaboração do texto como um movimento decolonial de (des)habitar a escrita acadêmica.

This article aims to discuss the reinvention of territories of peripheral childhoods and youths based on photographs and poems produced by photographer Leo Silva and poet Talles Azigon (identified after acceptance of the article) as a way of re-existing in Fortaleza. These are problematizations arising from the realization of an inter(in)vention research of cartographic ethos, with these young people, in which images and poems emerge as playful devices in the production of counter-hegemonic movements against the "official images" historically imposed on the peripheries. Through these photographs and poems, and, therefore, through art, the claim of territories portrays and narrates childhoods and youths on the outskirts of Fortaleza from their strengths and not from their precariousness. As an experiment, the article was produced from these poems and photographs, in addition to counting on the participation of (to be identified if the article is accepted, as it acts as a participant in the writing of the article) and (to be identified if the article is accepted, as it acts as a participant in the writing of the article) in the elaboration of the text as a decolonial movement (dis)inhabiting academic writing.

Programa Bolsa Família e a dinâmica de famílias quilombolas / Programa Bolsa Família and the dynamics of quilombola families / El programa Bolsa Família y la dinámica de familias quilombas

Objetiva-se discutir os efeitos do Programa Bolsa Família na dinâmica familiar e na gestão do cotidiano de mulheres beneficiárias e moradoras de duas comunidades quilombolas rurais do nordeste brasileiro. Entrevistou-se 72 mulheres por questionário sociodemográfico e entrevistas semiestruturadas. Há centralidade das mulheres como elemento organizador do cotidiano e responsável pelo estabelecimento de vínculos intergeracionais, como também elo agregador das comunidades na medida em que fazem a ponte entre o mundo doméstico e o comunitário. Observa-se a reprodução dos lugares tradicionais de gênero relacionados ao cuidado e à manutenção de desigualdades quanto à divisão de tarefas e tomada de decisão no interior das famílias, com sobrecarga para as mulheres. Nota-se interferências do BF nas dinâmicas familiares em três dimensões: relações conjugais, maternidade e cuidado dos filhos e relações comunitárias. Efeitos de autonomia e aumento no poder decisório podem ser sentidos, os quais rebatem em práticas de resistência e subversão no cotidiano.

The aim is to discuss the effects of the Programa Bolsa Família on the family dynamics and on the daily management of beneficiary women living two rural quilombola communities in the northeastern Brazil. 72 women were interviewed using a sociodemographic questionnaire and semi-structured interviews. There is a centrality of women as an organizg element of daily life and responsible for establishing intergenerational bonds, as well as a link that bring communities together insofar as they bridge the gap between the domestic world and the community. The reproduction of traditional gender roles related to care and the maintenance of inequalities regarding the division of tasks and decision-making within families is observed, with an overload for women. PBF interferes in family dynamics in three dimensions: marital relationships, motherhood and child care, and community relationships. Effects of autonomy and increase in decision-making power can be felt, which reflect in practices of resistance and subversion in everyday life.

El objetivo es discutir los efectos del Programa Bolsa Família en la dinámica familiar y en la gestión diaria de las mujeres beneficiarias que viven en dos comunidades rurales quilombolas en el noreste de Brasil. Se entrevistó a 72 mujeres mediante cuestionario sociodemográfico y entrevistas semiestructuradas. Hay una centralidad de las mujeres como elemento organizador la vida cotidiana y responsable de establecer lazos intergeneracionales, así como un vínculo de agregación de las comunidades, en la medida en que cierran la brecha entre el mundo doméstico y el comunitario. Se observa la reproducción de roles de género tradicionales relacionados con el cuidado y el mantenimiento de las desigualdades en cuanto a la división de tareas y toma de decisiones al interior de las familias, con sobrecarga para las mujeres. PBF interfiere la dinámica familiar en tres dimensiones: relaciones yugales, maternidad y cuidado de los hijos, y relaciones comunitarias. Se pueden sentir efectos de autonomía y aumento del poder de decisión, que se reflejan en las prácticas de resistencia y subversión en la vida cotidiana.

Povos indígenas e luta por garantia de direitos no Piauí, Brasil / Indigenous peoples and the struggle for guaranteed rights in Piauí, Brazil / Los pueblos indígenas y la lucha por los derechos garantizados en Piauí, Brasil

O presente estudo buscou refletir acerca do processo de mobilização étnica e política dos povos indígenas no Piauí, no intuito de conhecer as políticas públicas destinadas aos grupos indígenas no Estado; discutir o acesso de tais grupos aos serviços voltados à promoção dos direitos indígenas; e apresentar os avanços e impasses na operacionalização das políticas públicas propostas à população indígena piauiense. Trata-se de uma pesquisa qualitativa, apoiada na produção de sentido no cotidiano, uma forma de fazer pesquisa em Psicologia Social. Participaram 20 lideranças, mediante os seguintes recursos metodológicos: observação no cotidiano; conversa no cotidiano; entrevista semiestruturada. Em suma, observa-se que por não corresponderem aos marcadores identitários reconhecidos pelos grupos dominantes da sociedade, os grupos indígenas do Piauí têm sido discriminados, oprimidos e marginalizados, sendo constantemente recolocados e vistos sob uma imagem colonial e estereotipada do que é ser indígena, que (re)produzem relações de colonialidade no âmbito das relações institucionais e sociais.

This study sought to reflect on the process of ethnic and political mobilization of indigenous peoples in Piauí, in order to know the public policies aimed at indigenous groups in the State; discuss the access of such groups to services aimed at promoting indigenous rights; and present the advances and impasses in the implementation of public policies proposed to the indigenous population of Piauí. This is a qualitative research, supported by the production of meaning in daily life, a way of doing research in Social Psychology. Twenty leaders participated, through the following methodological re sources: daily observation; conversation in daily life; semistructured interview. In short, it is observed that because they do not correspond to the identity markers recognized by the dominant groups of society, the indigenous groups of Piauí have been discriminated, oppressed, and marginalized, being constantly replaced and seen under a colonial and stereotyped image of what it is to be indigenous, that (re)produces relationships of coloniality within the institutional and social relations.

Este estudio buscó reflexionar sobre el proceso de movilización étnica y política de los pueblos indígenas en Piauí, con el fin de conocer las políticas públicas dirigidas a los grupos indígenas en el Estado; discutir el acceso de dichos grupos a los servicios destinados a promover los derechos indígenas; y presentar los avances y estanciamentos en la implementación de las políticas públicas propuestas a la población indígena de Piauí. Se trata de una investigación cualitativa, basada en la producción de sentido en la vida cotidiana, una forma de hacer investigación en Psicología Social. Participaron 20 líderes, a través de los siguientes recursos metodológicos: observación diaria; conversación en la vida cotidiana; entrevista semiestructurada. En suma, se observa que no corresponder a las marcas identitarias reconocidas por los grupos dominantes de la sociedad, los grupos indígenas de Piauí han sido discriminados, oprimidos y marginados, siendo constantemente reemplazados y vistos bajo una imagen colonial y estereotipada de lo que es ser indígena, que (re)produce relaciones de colonialidad en el ámbito de las relaciones institucionales y sociales.

Produção de conhecimento, psicologia e pensamento decolonial / Production of knowledge, psychology and decolonial thinking

Esse estudo objetivou fazer um levantamento da produção latinoamericana em psicologia que toma por base o pensamento póscolonial e decolonial. Interessa-nos discutir as contribuições desses estudos e mapear quais críticas fazem aos paradigmas centrais da psicologia enquanto campo de saber e práticas profissionais. Realizamos uma revisão integrativa da produção bibliográfica sobre psicologia articulada ao pensamento decolonial no Portal de Periódicos Capes e Redalyc. Após o crivo de inclusão-exclusão, 30 artigos foram analisados. Os resultados apontam para a crítica à ênfase nos modelos teóricos e práticos advindos dos países centrais do capitalismo, a inadequação de teorias eurocêntricas na América Latina e a invisibilização da produção nacional e/ou latino-americana. Contudo, ainda são escassos os estudos na área que interrogam o racismo epistêmico e os modos de produção do conhecimento que aprofundam as experiências de colonialidade ao invisibilizar grupos destoantes do padrão de normatividade moderna.

Mulheres lideranças comunitárias e a luta quilombola / Community leadership women and the quilombola struggle / Mujeres lideresas comunitarias y la lucha de quilombola

Este estudo objetiva resgatar e analisar os processos de luta pelo reconhecimento das comunidades quilombolas do RN, com destaque ao processo de constituição das mulheres como lideranças políticas e comunitárias. Para tanto, realizamos observação participante e entrevistas semiestruturadas com 07 mulheres lideranças durante o Encontro das Comunidades Quilombolas do RN, em 2018. As entrevistas foram transcritas na íntegra e procedemos a análise de conteúdo, na modalidade Análise Temática. Os resultados revelam obstáculos institucionais ao processo de reconhecimento, às precárias condições de vida e de acesso às políticas públicas, à fragilidade do apoio comunitário, racismo, sexismo, à sobreposição das funções doméstica, agrícola e comunitária. Assim, para as mulheres encampar a luta quilombola representa uma dupla batalha: de um lado, o reconhecimento da própria comunidade como quilombola; e, de outro, o reconhecimento de seu lugar enquanto mulheres negras, produzindo enfrentamentos às opressões de gênero e ao racismo nas suas diversas expressões.

This study aims to rescue and analyze the processes of struggle for the recognition of quilombola communities in Rio Grande do Norte, with emphasis on the process of constitution of women as political and community leaders. To this end, we carried out participant observation and semi-structured interviews with 07 women leaders during the Meeting of Quilombolas Communities of RN, in 2018. The interviews were transcribed in full and we proceeded to content analysis, using Thematic Analysis modality. The results reveal institutional obstacles to the recognition process, the precarious living conditions and access to public policies, the fragility of community support, racism, sexism, the overlapping of domestic, agricultural and community functions. Thus, for women to take up the quilombola struggle represents a double battle: on the one hand, the recognition of the community itself as quilombola; and, on the other hand, the recognition of their place as black women, producing confrontations with gender oppression and racism in its various manifestations.

Este estudio tiene como objetivo rescatar y analizar los procesos de lucha por el reconocimiento de las comunidades quilombolas de RN, con énfasis en el proceso de constituir a las mujeres como líderes políticos y comunitarios. Para esto, llevamos a cabo una observación participante y entrevistas semiestructuradas con 07 mujeres líderes durante la Reunión de Comunidades de Quilombolas de RN, en 2018. Las entrevistas se transcribieron en su totalidad y se procedió al análisis de contenido, en la modalidad de Análisis temático. Los resultados revelan los obstáculos institucionales para el reconocimiento, las precarias condiciones de vida y de acceso a las políticas públicas. La fragilidad del apoyo mutuo, el racismo, el sexismo, y la superposición de las funciones domésticas, agrícolas y comunitarias. Por lo tanto, para las mujeres asumir la lucha quilombola representa una doble batalla: por un lado, el reconocimiento de la comunidad misma como quilombola; y, por otro, el reconocimiento de su lugar como mujeres negras, produciendo confrontaciones con la opresión de género y el racismo en sus expresiones más diversas.

Atenção psicossocial nos serviços de atenção primária à saúde: desafios à integração no Brasil / Psychosocial care in primary health care services: challenges to integration in Brazil

Objetiva-se apresentar um panorama da Atenção Primária à Saúde Mental no Brasil com destaque para as equipes NASF. Utilizou-se dados da Coordenação Nacional de Saúde Mental, do Departamento da Atenção Básica e do segundo e terceiro ciclos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Observou-se desequilíbrios entre a oferta e a demanda de serviços, pontos de estagnação e distorções no processo de universalização da Atenção Psicossocial, com a existência de vazios assistenciais no território nacional. A capacidade de resposta da Atenção Primária à saúde mental tem ficado comprometida quanto à efetividade, continuidade dos cuidados, equidade e acessibilidade. Nota-se o agravamento desse quadro no cenário atual de crise econômica, social e política e no contexto pandêmico em curso. Palavras-chave: Atenção primária à saúde. Saúde mental.Atenção psicossocial. Sistema Único de Saúde (SUS).

The objective is to present an overview of Primary Mental Health Care in Brazil with emphasis on NASF teams. We used data from the National Mental Health Coordination, from the Department of Basic Care and from the second and third cycles of the National Program for Improvement of Access and Quality of Basic Care. It was observed imbalances between supply and demand of services, break points, and important distortions in the process of universalization of psychosocial care, with the existence of care gaps in the national territory. The response capacity of primary care to mental health has been compromised in terms of effectiveness, continuity of care, equity, and accessibility. The worsening of this situation is noted in the current scenario of economic, social, and political crisis and in the ongoing pandemic context. Keywords: Primary health care. Mental health. Psychosocial care. Brazilian Public Health Care System (SUS).

Analysis of the reasons for hospitalization of elderly people in the extreme north of Brazil / Análise dos motivos de internação hospitalar de idosos no extremo norte do Brasil

Objective: to characterize the reasons for hospitalization of the elderly from 2015 to 2019 in Roraima, Brazil. Methods: descriptive epidemiological study, under a temporal analysis of data from the Hospital Information System regarding hospitalizations of the elderly. Age groups, length of stay, sex, rate of admissions, diagnoses and variations in the ranking of causes of the same were evaluated. Results: 23,844 hospitalizations among elderly people in the state were recorded. Diseases of the circulatory, respiratory and digestive systems represented the main groups associated with hospitalizations (44.2% of the total). The male population was predominant in hospitalizations and the population aged 80 years or more recorded the highest percentages of hospitalizations. Pneumonia, diabetes mellitus, heart failure and hospitalization for examinations and investigation were the diagnoses with the highest placement in the ranking of specific causes. Conclusion: There is a predominance of elderly men in hospitalizations, and a higher percentage of hospitalizations among many elderly people (over 80 years old) (AU)

Objetivo: caracterizar os motivos de internação hospitalar de idosos de 2015 até 2019 em Roraima, Brasil. Métodos: estudo epidemiológico descritivo, sob análise temporal de dados do Sistema de Informações Hospitalares referentes às hospitalizações de idosos. Foram avaliadas faixas etárias, período de internação, sexo, taxas de internações, diagnósticos e variações no ranking das causas das mesmas. Resultados: foram registradas 23.844 internações em idosos no Estado. As doenças dos aparelhos circulatório, respiratório e digestório representaram os principais grupos associados às internações (44,2% do total). Houve predomínio da população masculina nas internações e a população com 80 anos ou mais registrou as maiores porcentagens. Pneumonia, diabetes mellitus, insuficiência cardíaca e internação para realização de exames e investigação foram os diagnósticos com maiores colocações no ranking de causas específicas. Conclusão: Observa-se predomínio de homens idosos nas internações, além de maior porcentagem de internações dos muitos idosos (acima de 80 anos) (AU)