Advance Care Planning in Brazil.

Brazil is a country of continental size marked by extreme social inequalities. Its regulation of Advance Directives (AD) was not enacted by law but within the scope of the norms that govern the relationships between patients and physicians, as a resolution of the Federal Medical Council without any specific requirement for notarization. Despite this innovative starting point, most of the debate regarding Advance Care Planning (ACP) in Brazil has been dominated by a legal transactional approach focused on making decisions in advance and the creation of AD. Yet, other novel ACP models have recently emerged in the country with a focus on the creation of a specific quality of relationship between patients, families, and physicians aiming at the facilitating future decision-making. Most of the education on ACP in Brazil happens in the context of palliative care courses. As such, most ACP conversations are performed within palliative care services or by healthcare professionals with training in that area. Hence, the scarce access to palliative care services in the country means that ACP is still rare and that those conversations usually happen late in the course of disease. The authors posit that the existing paternalistic healthcare culture is one of the most important barriers to ACP in Brazil and envision with great concern the risk that its combination with extreme health inequalities and the lack of healthcare professionals' education on shared decision-making could lead to the misuse of ACP as a form of coercive practice to reduce healthcare use by vulnerable populations.

Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care.

Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision aids tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.

Politics and power in ultra-modernity.

This work addresses three main issues: (i) Jung's positions on the historical events that he lived through, which are mainly presented in Volume 10 of his Collected Works; (ii) a reflection from a psychological perspective on the times we are experiencing, identifying the main contemporary psychopathologies; (iii) the possibility and need for including the pathologies of our time in our psychotherapeutic work.

Ce travail s'occupe de trois sujets principaux: 1) les positions de Jung concernant les événements historiques qu'il traversa durant sa vie, et qui sont présentées principalement dans le Volume 10 des Œuvres Complètes, 2) une réflexion sur l'époque que nous vivons, du point de vue psychologique, en identifiant les psychopathologies majeures de notre époque, 3) la possibilité et la nécessité d'inclure les pathologies de notre époque dans notre travail psychothérapeutique.

El presente trabajo aborda tres temas principales: (i) La posición de Jung respecto a los eventos históricos que lo atravesaron, y que han sido principalmente presentados en el Volumen 10 de sus Obras Completas; (ii) una reflexión desde una perspectiva psicológica sobre los tiempos que estamos experimentando, identificando las principales psicopatologías contemporáneas; (iii) la posibilidad y la necesidad de incluir las patologías de nuestro tiempo en nuestro trabajo psicoterapéutico.

Este trabalho aborda três questões principais: (i) as posições de Jung sobre os eventos históricos que ele viveu, que são apresentados principalmente no Volume 10 de suas Obras Coletadas; (ii) uma reflexão a partir de uma perspectiva psicológica sobre os tempos que estamos vivenciando, identificando as principais psicopatologias contemporâneas; (iii) a possibilidade e a necessidade de incluir as patologias do nosso tempo em nosso trabalho psicoterapêutico.

Brazil: hate and intolerance in times of pandemic in a mixed-race country.

This paper intends to analyse the current political and social situation in Brazil and show how this context has influenced the management of the public health crisis generated by the COVID-19 pandemic. To this end, the authors conducted an investigation into Brazil's historical roots, which have not only engendered deep class differences but, also, social psychopathologies such as dissociation and perversion. Finally, this paper presents a symbolic analysis of social exclusion and how the mythical figure of Sophia can inspire a renewed movement of inclusion and tolerance.

Cet article se propose d'analyser la situation politique et sociale actuelle au Brésil et de montrer comment ce contexte a influencé la gestion de la crise sanitaire publique générée par la COVID-19. Dans ce but, les autrices ont conduit une enquête approfondie sur les racines historiques du Brésil, racines qui ont engendré non seulement de profondes différences de classes mais également des psychopathologies sociales, telles la dissociation et la perversion. Cet article présente en conclusion une analyse symbolique de l'exclusion sociale et montre comment le personnage mythique de Sophia peut inspirer un mouvement renouvelé d'inclusion et de tolérance.

El presente trabajo intenta analizar la situación actual política y social en Brasil y muestra como este contexto ha influenciado el manejo de la crisis de la salud pública generada por la pandemia del COVID-19. A este fin, las autoras llevaron a cabo una investigación sobre las raíces históricas de Brasil, las cuales, no solamente han generado profundas diferencias de clase, sino también psicopatologías sociales como disociación y perversión. Finalmente, el presente trabajo presenta un análisis simbólico de la exclusión social y cómo la figura mítica de Sophia puede inspirar un movimiento renovador de inclusión y tolerancia.

[Leonhard Riedmüller: Swiss public enemy or pawn sacrifice?] / Leonhard Riedmüller: Schweizer Staatsfeind oder Bauernopfer?

INTRODUCTION: On June 9, 1945 the Zurich cantonal government issued the lifetime deportation from Switzerland for Prof. Dr. med. vet. Leonhard Riedmüller (1898-1976) and his spouse Helena, née Eltze (1910-1990), both German citizens on grounds of Riedmüllers' membership in the NSDAP, "Landesgruppe Schweiz". Riedmüllers' several attempts to appeal at court were not successful. Riedmüllers biography shows that he served in the German Army at the Western front during WW I. Following the war he studied Veterinary Medicine at the University of Munich where he received the degree of Dr. med. vet. Moving to Zurich in 1926, Riedmüller took a position as veterinary bacteriologist at the University of Zurich. In 1941 he was promoted and became head of the Institute of Veterinary Bacteriology. He left Europe in 1947 for Brazil and took a position as a veterinary bacteriologist at a government laboratory. After retiring from his position in Brazil he returned to Germany where he passed away in 1976. Based on available documents from several Swiss archives the question is discussed whether Riedmüllers' deportation as public enemy in 1945 was appropriate or if Swiss authorities might have been tempted to sacrifice Riedmüller as a pawn in consideration of Switzerlands international political position immediately after the end of WW II.

Shared decision making in Brazil: Concrete efforts to empower the patients' voice.

Patient involvement in healthcare decisions has grown in Brazil at three different levels: 1) the macro level, which includes the patient actively influencing legislation and regulation of medical care as well as political changes in the process of care itself; 2) the meso level, which includes institutions that aim to improve information, empowerment and counseling to patients, and 3) the micro level, which focuses on the actual decision-making process that takes place within patient-physician encounter. In Brazil, the macro and meso levels are stronger than the micro one. In this paper, the practical efforts to engage patients in the center of their own care are presented. In order to do that, an overview on the National Humanization Policy and the Brazilian patient's movement is provided.

Wissen produzieren, lokalisieren und imaginieren. Von "falschen Karten" und "wissenschaftlichen Expeditionen" in der Auseinandersetzung um Guyana (1880er bis 1900er Jahre).

Producing, Localising, and Imagining Knowledge. On "false maps" and "scientific expeditions" in the Brazilian-French Debates about Guyana (1880s-1900s). This paper analyses the interferences between knowledge production, space and colonial claims from translocal, actor-based perspectives. Due to its 'thickness' the examined material, found particularly at the Perthes collection (Gotha/Germany), allows multifaceted views on a topic which influences our scientific knowledge-based world views. In his writings the Swiss naturalist Emil Göldi underlined his point of view that was both 'Brazilianized' and scientific. Especially his letters and articles between the 1880s and the 1900s are testimony to his positioning in situ ('an Ort und Stelle') against the cartographic 'alienated'-colonial perspectives of French scientists, especially those of his counterpart Henri Coudreau. Sometimes it reads more like an adventure story than a scholarly debate. By working with and using the internationally renowned periodical Petermanns Geographische Mitteilungen (Perthes), Göldi managed to design an image of the spatial situation that convinced the deciding people and thus to obtain for Brazil a huge territory in the Eastern part of the Guyanas.

How health economic evaluation (HEE) contributes to decision-making in public health care: the case of Brazil.

The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned - (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease.

O processo de trabalho na supervisão clínico-institucional nos centros de atenção psicossocial (caps) / The process of working in clinical-institutional supervision at brazilian psychosocial treatment centers, referred to as caps / Le processus de travail de la supervision clinico-institutionnel des centres de soins psychosociaux - caps / El proceso de trabajo de la supervisión clínico-institucional en los centros de atención psicosocial - caps

O objetivo deste estudo é descrever e analisar o processo de trabalho dos supervisores clínico-institucionais dos Centros de Atenção Psicossocial (CAPS) no Rio Grande do Sul, Brasil. Trata-se de uma pesquisa exploratório-descritiva, com abordagem qualitativa. Os sujeitos foram dez supervisores, e a técnica de coleta de dados foi feita a partir de entrevistas semiestruturadas. Os dados foram submetidos à análise temática. Como resultados identificaram-se ferramentas utilizadas pelo supervisor como suporte para sua prática no processo de trabalho, destacando-se: o mapeamento do processo de trabalho no CAPS, a experiência profissional na clínica e na saúde pública, com ênfase no SUS, o uso da escuta e da palavra, e a construção coletiva dos casos clínicos.

The aim of this study is to describe and analyze the working process of clinical and institutional supervisors at Psychosocial Treatment Centers (CAPS) in the state of Rio Grande do Sul, Brazil. This is an exploratory and descriptive study based on a qualitative approach. The subjects were ten supervisors and the data was gathered through semi-structured interviews. The data was submitted to theme analysis. The results presented instruments used by supervisors as they carry out their work, such as mapping the working processes at the centers, as well as their clinical experience and broader professional experience in the Brazilian public health system, listening to patients as they talk, and the collective construction of clinical cases.

Le but de cet étude est de décrire et d'analyser le processus de travail des superviseurs clinico-institutionnels des Centres de Soins Psychosociaux (CAPS) du Rio Grande do Sul, Brésil. Il s'agit d'une recherche exploratoire et descriptive, d'approche qualitative. Les sujets étaient composés de dix superviseurs et les données ont été obtenues par moyen d'entretiens semi-directifs. Les données ont ensuite été soumises à une analyse thématique. Les résultats portaient sur les outils utilisés par les superviseurs comme support de travail aux Centres, soit: la cartographie du processus de travail aux Centres, l'expérience professionnelle acquise en clinique et dans le système de santé publique brésilien (SUS), l'usage de l'écoute et de la parole, ainsi que la construction collective des cas cliniques.

El objetivo de este estudio fue describir y analizar el proceso de trabajo de los supervisores clínico-institucionales de los Centros de Atención Psicosocial (CAPS) en Río Grande del Sur, Brasil. Se trata de una pesquisa de carácter exploratoria y descriptiva, con abordaje cualitativa. Los sujetos fueron diez supervisores, y la técnica de colecta de datos utilizada fueron entrevistas semi-estructuradas. Los datos fueron examinados por el método del análisis temático. Como resultados se identificaron herramientas utilizadas por el supervisor como soporte para su práctica en el proceso de trabajo, destacándose: el delineamiento del proceso de trabajo en el CAPS, la experiencia profesional en la clínica y en la salud pública con énfasis en el SUS, el uso de la escucha y de la palabra, y la construcción colectiva de casos clínicos.

As origens do alienismo no Brasil: dois artigos pioneiros sobre o Hospício de Pedro II / The origins of insane asylums in Brazil: two pioneer articles on Hospício de Pedro II (Pedro II Insane Asylum, Rio de Janeiro) / Les origines de l'aliénisme au Brésil: deux articles pionniers sur l'Hospice Pedro II / Los orígenes del alienismo en Brasil: dos artículos sobre el Hospício Pedro II

O artigo discute dois trabalhos que, de forma pioneira, descreveram o funcionamento do Hospício de Pedro II, primeira instituição psiquiátrica do Brasil: L'hospice Pedro II et les Alienés au Brésil, de Phillipe-Marius Rey (1875); e Visite a L'sile de Pedro II a Rio de Janeiro, de François Jouin (1880). O contexto histórico de criação do hospício e seu funcionamento inicial são analisados. Sua construção é correlacionada à afirmação política do Segundo Reinado. Aspectos referentes à organização do alienismo no país e às características raciais da sociedade brasileira são abordados.

This article discusses two important documents in Brazilian psychiatric history. One was written by Phillipe-Marius Rey (1875) and entitled "L'hospice Pedro II et les Alienés au Brésil." It described the operations of the Pedro II Asylum, located in Rio de Janeiro, which was the first psychiatric institution in Brazil. The second document was "Visite a L'asile de Pedro II a Rio de Janeiro," by François Jouin (1880). In these texts the historical context of its founding and initial operations of the asylum are analyzed. Its establishment is related to the political realities of the 19th century. Aspects concerning organization of the treatment of the insane in Brazil, and society's racial characteristics there are mentioned.

Cet article analyse deux études qui, de façon inédite, ont décrit le fonctionnement de l'Hospice Pedro II, la première institution psychiatrique brésilienne: ®L'Hospice Pedro II et les aliénés au Brésil¼, de Marius-Philippe Rey (1875), et ®Visite à l'Asile Pedro II à Rio de Janeiro¼, de François Jouin (1880). Le contexte historique de la création de l'hospice, ainsi que son fonctionnement initial sont analysés. Sa construction est corrélée à l'affirmation politique du Second Règne. Des aspects concernant l'organisation de l'aliénisme au Brésil et les caractéristiques raciales de la société brésilienne y sont traités.

El artículo analiza dos estudios que, por primera vez, han descrito el funcionamiento del hospicio Pedro II, la primera institución psiquiátrica en Brasil: "L'hospice Pedro II et les alienés au Brésil", de PhillipeMarius Rey (1875); y "Visite a L'asile de Pedro II a Rio de Janeiro", de Francois Jouin (1880). Se analiza el contexto histórico de la creación del hospicio y su funcionamiento inicial. Su construcción se relaciona con la afirmación política del Segundo Reinado. Además se abordan aspectos que tienen que ver con la organización del alienismo y con las características raciales de la sociedad brasileña.