Crowdfunding for Complementary and Alternative Cancer Treatments in Tijuana, Mexico: Content Analysis.

BACKGROUND: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. OBJECTIVE: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. METHODS: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary's cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. RESULTS: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). CONCLUSIONS: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one's time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment.

Clinical territories.

The author reflects on the extension of the psychoanalytic clinic, showing how ideas, studies and discussions built up over several years have led various Latin American groups to put their thinking into action, by allowing themselves to be penetrated by issues of the city and directly relate to diverse territories. These studies have shown how psychoanalytic actions can take place in various types of encounter between subjectivities, highlighting their challenges as well as their effectiveness and power.

Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study.

Background: Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic. Methods: A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis. Results: In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14). Conclusion: This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.

Prevalence of syphilis among people living with HIV who attend a large antiretroviral therapy clinic, Panama, 2022 Syphilis is a significant health challenge worldwide. On a global scale, yearly syphilis incidence is increasing, including in Panama. However, there are no current data to explain syphilis prevalence and who is most affected among people living with HIV in Panama. In order to understand syphilis in Panama and create targeted interventions among specific groups of people, it is important to describe how many people are infected, and who is most affected by this infection. Therefore, we conducted a study among 378 people living with HIV at a treatment clinic in Panama City, Panama. Blood samples and demographic data were collected. In all, syphilis antibodies were found in 32.3% of individuals (50.7% of those who self-report as males, 5.7% as females, and 100% of those who self-report as intersex. Of those with positive antibody tests, 24.6% of individuals also had active syphilis. Only individuals who identify as male had active syphilis. Our findings show high syphilis prevalence among people with HIV in Panama City, particularly among males, those who are younger, those who report sexual identity as homosexual or bisexual, and those with ongoing sexual relationships with more than one individual. Targeted interventions are needed among people living with HIV, especially among the groups most affected. These interventions could include testing more often for syphilis and providing timely treatment, especially among individuals who may be at increased risk of infection.

Prevalence and clinico-pathology of PSOROPTIC mange in buffaloes of the Amazon region.

Scabies is an important skin disease in several species of domestic and wild animals; however, few reports in Brazil have emphasized its occurrence in buffaloes. This article describes the epidemiological, clinical and pathological aspects and diagnosis of psoroptic mange in buffaloes in a property in the municipality of Castanhal, PA, Amazon region. Of the 41 buffaloes examined, 38 males and females of the Murrah, Baio, Mediterranean and Carabao breeds and their crossbreeds, aged between 2 and 20 years, had a history of pruritus. Clinical examination was performed to map the lesions, skin scrapings were collected to identify the mites, and a biopsy was performed for histopathological examination. Clinical signs, from mild to severe intensity, varied according to the system of creation and handling of the animals and were more severe in buffaloes raised in bays than those raised under a collective regime (pastures and collective troughs). The characteristic clinical signs were intense itching, extensive areas of alopecia, periocular edema, and thickening of the epidermis with exudative crusts covering the face, chamfer, neck, scapular region, back, base of the horn, thoracic and pelvic limbs and chest. The behavior of rubbing the affected regions of the body against structures (troughs, fence posts, gates) or with the horns was frequently observed and provided relief from itching. In the most severe cases, mites were also noted in the crusts, which were identified as Psoroptes natalensis. Histological skin lesions exhibited alterations consistent with immune-mediated dermatitis, which is typical of hypersensitivity to mite-derived allergens.

Pistas genealógicas de um Consultório na Rua: criminalização e assimilação / Genealogical clues from a Street Clinic: criminalization and assimilation / Pistas genealógicas de un Consultorio em la Calle: criminalización y asimilación

Este artigo, por meio de aproximação genealógica, buscou investigar o que chamaremos de pistas genealó-gicas do equipamento Consultório na Rua em município de médio porte no Sul do Brasil. Para o percurso da pesquisa, junto a uma vivência em um Consultório na Rua, nesse município do país, foram realizados entrevistas e levantamentos de documentos. Na investigação foi possível encontrar pistas que apontam para uma produção de criminalização e assimilação histórica dos viventes da rua pelo Estado brasileiro, de maneira que esses pontos precisam ser discutidos e problematizados para que tais regimes de verdade não sejam norteadores das políticas públicas para tais pessoas.

This article, employing a genealogical approach, aimed to examine the genealogical traces of the Street Clinic equipment in a medium-sized city in Brazil's southern region. In order to follow the path of the research, along with an experience in a Street Clinic in a Brazilian city, interviews and document surveys were conducted. In the investigation, it was possible to find elements of the production of criminalization and historical assimilation by the Brazilian State that need to be discussed and problematized so that such regimes of truth are not guiding the production of health care for people experiencing homelessness.

Este artículo, a través de un abordaje genealógico, buscó investigar pistas genealógicas del Consultorio en la Calle en una ciudad de tamaño medio en el sur de Brasil. Para el transcurso de la investigación, junto con una experiencia en un Consultorio en la Calle en un municipio de tamaño medio en el sur de Brasil, se efectuaron entrevistas y encuestas documentales. En la investigación, fue posible encontrar pistas que apuntan a una producción de criminalización y asimilación histórica de las personas en situación de calle por parte del Estado brasileño, por lo que estos puntos necesitan ser discutidos y problematizados para que tales regímenes de verdad no guíen políticas públicas para dicha población.

Administración del consultorio odontológico en contextos inflacionarios / Dental clinic administration in inflationary contexts

La administración es una herramienta fundamental que permite planificar, desarrollar y organizar cualquier empresa, independientemente del tamaño de la misma. Tener una sana administración del consultorio odontológico es imprescindi- ble para la toma de decisiones, más aún en contextos de crisis y alta inflación (AU)

Administration is a fundamental tool that allows plan- ning, developing, and organizing any company, regardless of its size. Having a healthy administration of the dental clinic is essential for decision making, even more so in contexts of crisis and high inflation (AU)

Entre territórios pandêmicos: cartografia de um Consultório na Rua durante a pandemia de covid-19 / Exploring pandemic territories: cartography of a street clinic during the covid-19 pandemic / Entre territorios pandémicos: cartografía de un Consultorio en la Calle durante la pandemia de covid-19

O objetivo do presente artigo foi realizar uma cartografia de um Consultório na Rua, durante o período da pandemia de covid-19. A cartografia foi produzida por uma vivência no consultório de um município de grande porte no sul do Brasil, de agosto de 2021 a janeiro de 2022. Foi perceptível que a locomoção e o funcionamento do serviço reconhecem outros territórios das Pessoas em Situação de Rua, muitas vezes não percebidos por outros pontos do Sistema Único de Saúde. Foram encontradas tanto as barreiras já estabelecidas historicamente quanto as emergentes da pandemia. Foi vivenciado que a esta população não utiliza o território do modo que a cidade racionalizada planeja, sendo, portanto, singular. O reconhecimento do serviço, aliado à compreensão de como as Pessoas em Situação de Rua vivem no território urbano, em cada realidade, mostrou-se essencial para a produção de cuidado.

The objective of this article was to conduct a cartographic study of a street clinic during the covid-19 pandemic. The cartography was based on an experiential approach in a street clinic located in a major city in southern Brazil, between August 2021 and January 2022. It became evident that the flows and operation of the service acknowledged the alternative territories inhabited by the homeless population, often overlooked by other parts of Brazil's Unified Health System. Both historically established barriers and those emerging from the pandemic were encountered. It was observed that the homeless population does not conform to rationalized urban plans, displaying unique patterns of engagement with the urban territory. Recognizing the significance of the service, coupled with a comprehensive understanding of the unique living conditions of homeless individuals, proved indispensable for the provision of effective care.

El objetivo de este artículo fue realizar una cartografía de un Consultorio en la Calle durante el período de la pandemia del covid-19. La cartografía fue producida por una experiencia en un Consultorio en la Calle en una gran ciudad del sur de Brasil, de agosto de 2021 a enero de 2022. Se pudo observar que la locomoción y operación del servicio reconocen otros territorios habitados por personas en situación de calle, a menudo no percibidos por otros puntos del Sistema Único de Salud. Se encontraron barreras, tanto históricamente establecidas como emergentes debido a la pandemia. Se constató que la población en situación de calle no utiliza el territorio de la forma planificada por la ciudad racionalizada. El reconocimiento del servicio, junto con la comprensión de cómo viven las personas en situación de calle en el territorio urbano en cada realidad, se mostró fundamental para la producción del cuidado.

Clinical and epidemiological profile of patients with mental disorders in a specialized outpatient clinic and its role in the psychosocial care network.

Introduction: Mental health disorders (MHDs) are responsible for much impairment of quality of life in Brazil and worldwide. Early diagnosis and effective treatment strategies are required due to the heterogeneous symptoms and multifactorial etiology. Methods: A descriptive retrospective observational study was performed aiming to characterize the clinical and psychiatric profiles of patients with MHD attending a Brazilian public tertiary psychiatric outpatient clinic, which is a reference health service for more than 2 million inhabitants. Predominant clinical and sociodemographic aspects of patients were evaluated between March 2019 and March 2021. Results: A total of 8,384 appointments were analyzed. The majority of patients were female, and the mean age was 45 years old. Generalized anxiety disorder (GAD) was the most common MHD. The prevailing symptoms were sadness, anxiety, and irritability, with the most prescribed medications being selective serotonin reuptake inhibitors. Conclusion: The epidemiological characterization of mental disorders in specialized mental health outpatient clinics provides evidence for the establishment of more specific protocols and advocates a dimensional transdiagnostic approach as an aid to public mental health services.

Independent clinic-based evaluation of dual POCTs for screening for HIV and syphilis in men who have sex with men in Italy, Malta, Peru, and the United Kingdom.

INTRODUCTION: Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM). METHOD AND ANALYSES: A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites. RESULTS: Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs). CONCLUSIONS: Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings.

Adherence to PKU guidelines among patients with phenylketonuria: A cross-sectional national multicenter survey-based study in Argentina, Brazil, and Mexico.

Objective: To characterize adherence to Phenylketonuria (PKU) management practices among PKU patients treated at reference sites around Argentina, Brazil, and Mexico. Methods: This is a retrospective, observational, multicenter, and multinational survey-based study using aggregate data. From an initial list of 40 sites, 22 clinicians expressed interest in completing the survey, with 20 clinicians from 20 unique sites fulfilling all the study criteria. The Survey contained 28 questions, including respondent's clinic characteristics, clinic PKU treatment recommendations, and patient adherence to clinic recommendations. Survey was available in local languages, and the respondents were asked to consult their clinic records to complete their responses. Adherence was assessed by target blood phenylalanine (Phe), target blood testing frequency, and clinic visits. Results: A total of 1077 (out of 1377) actively managed PKU patients (seen in the clinic in the last 3 years) from 13 clinics in Brazil, six in Argentina, and one in Mexico were analyzed. Upper blood Phe target was set over 360 µMol/L in 70% of the clinics for adult patients. Around 40% of the patients >30 years old had Phe blood tests done twice a year or less, with 60% of the clinics recommending semestral visits for adults <30 years old. Twice a month was the most common frequency of visits for <1 year old. The COVID-19 pandemic was a disruptor for frequency of visits and exams. Conclusions: These results show that there is still room for improvement in terms of adherence, namely in adults and older children. More efforts must be made to educate patients and healthcare professionals about the importance of treatment adherence, accompanied by public policies that expand access to pharmacological and dietary treatment with diversity and quality to improve adherence to adequate blood Phe levels.

Ambulatory amoxicillin use for common acute respiratory infections during a national shortage: Results from the SHARPS-OP benchmarking collaborative.

We quantified antibiotic prescribing for ambulatory pediatric acute respiratory illness at 22 institutions in "pre-shortage" (Jan 2019-Sep 2022) and "shortage" (Oct 2022-Mar 2023) periods for amoxicillin. While acute respiratory illness prescribing increased across settings, the proportion of amoxicillin prescriptions decreased. Variation was seen within and between institutions.

External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Ferenczi e a clínica psicanalítica contemporânea: uma revisão sobre suas contribuições ao papel do analista / Ferenczi and the contemporary psychoanalytic clinic: a review of his contributions to the role of the analyst / Ferenczi et la clinique psychanalytique contemporaine: une revue de ses contributions au rôle de l'analyste / Ferenczi y la clínica psicoanalítica contemporánea: Una revisión de sus contribuciones al papel del analista

Objetivou-se fazer uma revisão sistemática da produção científica nacional e internacional, no período de 2015 a 2020, sobre a obra de Sándor Ferenczi e suas contribuições à clínica psicanalítica na contemporaneidade, no que concerne ao papel do analista. Os seguintes descritores foram utilizados: "Ferenczi" "clínica psicanalítica" e "analista". As bases de dados pesquisadas foram: P@rthenon, SciELO e Pepsic. Foi utilizada a metodologia da Análise de Conteúdo. O processo de análise levou a leitura dos títulos, resumos e textos completos, e 52 artigos preencheram os critérios. A pesquisa compreendeu que a retomada dos trabalhos de Ferenczi quanto ao papel do analista evidenciam uma nova configuração de relação analítica baseada em uma ética do cuidado. O papel do analista apresenta-se como uma possibilidade de contorno e sustentação às experiências traumáticas, colaborando com o paciente, na produção de sentidos e elaborações dessas experiências

This is a systematic review of national and international scientific papers published between 2015 and 2020 on Sándor Ferenczi's work and his contributions to the contemporary psychoanalytic clinic, mainly regarding the role of the analyst. Search was conducted on the P@rthenon, Scielo and Pepsic databases using "Ferenczi," "psychoanalytic clinic" and "analyst" as search descriptors. After reading the titles, abstracts and full texts a total of 52 articles met the inclusion criteria. Resumption of Ferenczi's work on the role of the analyst reveals a new configuration of analytical relations based on an ethics of care. The analyst presents a possibility of shaping and underpinning traumatic experiences, collaborating with the patient to produce meanings and elaborations of these experiences

Il s'agit d'une revue systématique des articles scientifiques nationaux et internationaux publiés entre 2015 et 2020 sur l'œuvre de Sándor Ferenczi et ses contributions à la clinique psychanalytique contemporaine, notamment en ce qui concerne le rôle de l'analyste. La recherche a été effectuée sur les bases de données P@rthenon, Scielo et Pepsic en utilisant « Ferenczi ¼, « clinique psychanalytique ¼ et « analyste ¼ comme descripteurs. Après la lecture des titres, des résumés et des textes intégraux, 52 articles répondaient aux critères d'inclusion. La reprise des travaux de Ferenczi sur le rôle de l'analyste révèle une nouvelle configuration des relations analytiques fondées sur une éthique du soin. L'analyste offre la possibilité de concevoir et d'étayer les expériences traumatiques, en collaborant avec le patient pour produire de significations et d'élaborations de ces expériences

El objetivo fue realizar una revisión sistemática de la producción científica nacional e internacional, en forma de artículo científico, de 2015 a 2020, sobre la obra de Sándor Ferenczi y sus aportes a la clínica psicoanalítica en la contemporaneidad, en torno al papel del analista. Se utilizaron los siguientes descriptores: "Ferenczi", "clínica psicoanalítica" y "analista". Las bases de datos buscadas fueron: P@rthenon, Scielo y Pepsic. Se utilizó la metodología de Análisis de Contenido. El proceso de análisis condujo a la lectura de títulos, resúmenes y textos completos y 52 artículos cumplieron los criterios. La investigación entendió que la reanudación del trabajo de Ferenczi sobre el rol del analista revela una nueva configuración de relación analítica basada en una ética del cuidado. El rol del analista se presenta como una posibilidad de modelar y sostener experiencias traumáticas, colaborando con el paciente, en la producción de significados y elaboraciones de estas experiencias

A clínica ampliada e o trabalho dos psicólogos no PAIF: pressupostos e desafios / The expanded clinic and the work of psychologists at PAIF: assumptions and challenges / La clínica ampliada y el trabajo de los psicólogos del PAIF: supuestos y desafíos

Resumo O presente trabalho tem como objetivo, a partir de uma pesquisa qualitativa de cunho bibliográfico, refletir sobre a clínica ampliada como uma possível ferramenta para o psicólogo exercer suas práticas cotidianas no contexto das políticas públicas, especificamente no Sistema Único de Assistência Social (SUAS), no trabalho com famílias do Programa de Atenção Integral à Família (PAIF), se diferenciando do modelo de clínica tradicional. Inicialmente, foi realizado um levantamento sobre a clínica ampliada no Brasil e seus fundamentos para, em um segundo momento, elencar possíveis articulações da atuação do psicólogo no PAIF com a clínica ampliada, a fim de refletir e ressignificar as atividades dessa categoria profissional no âmbito da proteção social prevista pelo SUAS. Concluiu-se que pressupostos presentes na clínica ampliada - como, por exemplo, a análise das demandas concretas das populações atendidas, garantia de direitos, negação do usuário enquanto objeto e trabalho direcionado à emancipação dos sujeitos - também se encontram descritos nos documentos que parametrizam o SUAS, o que torna viável considerá-la como uma perspectiva possível para o trabalho da Psicologia no âmbito da Assistência Social.

Abstract This paper aims, based on a qualitative bibliographical research, to reflect on the expanded clinic as a possible tool for the psychologist to exercise his daily practices in the context of public policies, specifically in the Unified Social Assistance System (SUAS), in working with families from the Family Care Program (PAIF), differentiating itself from the traditional clinic model. Initially, a survey was carried out on the expanded clinic in Brazil and its foundations to, in a second moment, list possible articulations of the psychologist's performance in the PAIF with the expanded clinic, in order to reflect and re-signify the activities of this professional category within the scope of the social protection provided by SUAS. It was concluded that assumptions present in the extended clinic - such as, for example, analysis of the concrete demands of the populations served, guarantee of rights, denial of the user as an object and work aimed at the emancipation of the subjects - are also described in the documents that parameterize the SUAS which makes it feasible to consider it as a possible perspective for the work of Psychology in the context of Social Assistance.

Resumen Este trabajo tiene como objetivo, a partir de una investigación bibliográfica cualitativa, reflexionar sobre la clínica ampliada como posible herramienta para que el psicólogo ejerza sus prácticas cotidianas en el contexto de las políticas públicas, específicamente en el Sistema Único de Asistencia Social (SUAS), en el trabajo con familias del Programa de Atención a la Familia (PAIF), diferenciándose del modelo de clínica tradicional. Inicialmente, se realizó un levantamiento sobre la clínica ampliada en Brasil y sus fundamentos para, en un segundo momento, enumerar posibles articulaciones de la actuación del psicólogo en el PAIF con la clínica ampliada, con el fin de reflexionar y resignificar las actividades de esta. categoría profesional dentro del ámbito de la protección social que brinda el SUAS. Se concluyó que supuestos presentes en la clínica ampliada -como, por ejemplo, análisis de las demandas concretas de las poblaciones atendidas, garantía de derechos, negación del usuario como objeto y trabajo encaminado a la emancipación de los sujetos- también son descrito en los documentos que parametrizan el SUAS lo que posibilita considerarlo como una perspectiva posible para el trabajo de la Psicología en el contexto de la Asistencia Social.

O inacessível à fala: fenômenos borderlines e o manejo clínico da esfera não verbal / L'inaccessible à la parole: les phénomènes borderline et la gestion clinique de la sphère non verbale / The inaccessible to speech: borderline phenomena and the clinical management of the non-verbal sphere / Lo inaccesible al habla: fenómenos borderlines y el manejo clínico de la esfera no verbal

O artigo tem como objetivo investigar os processos de comunicação subjacentes à linguagem verbal presentes na relação analítica. Analisaremos como o conceito de transferência se modifica na literatura psicanalítica, abrindo espaço para as dinâmicas intersubjetivas do setting. Dialogando com a teoria do apego e seus fundamentos etológicos, apresentaremos os fenômenos borderlines, marcados por intensas manifestações corporais no contexto das relações interpessoais. Em seguida, defenderemos a hipótese de que há em todo sujeito um núcleo inacessível à fala, que aparece como material clínico principalmente na análise de pacientes graves, onde a experiência traumática se inscreve em níveis sensoriais.

Resumos This article aims to investigate the communication processes underlying verbal language found in the analytical relationship. We will analyze how the concept of transference changes in psychoanalytic literature, opening space for the intersubjective dynamics present in the setting. Dialoging with attachment theory and ethology, we will present borderline phenomena, marked by intense bodily manifestations in the context of interpersonal relationships. Then, we will defend the hypothesis that an inaccessible nucleus to speech lies in every subject, which appears as clinical material mostly in the analysis of severely ill patients, where traumatic experience is inscribed in sensory levels..

L'article vise à étudier les processus de communication qui sous-tendent le langage verbal présent dans la relation analytique. Nous analyserons l'évolution du 29 concept de transfert dans la littérature psychanalytique, en ouvrant un espace à la dynamique intersubjective du cadre. En dialogue avec la théorie de l'attachement et ses fondements éthologiques, nous présenterons les phénomènes limites, marqués par des manifestations corporelles intenses dans le contexte des relations interpersonnelles. Nous défendrons ensuite l'hypothèse qu'il existe chez tout sujet un noyau inaccessible à la parole, qui apparaît comme matériel clinique principalement dans l'analyse des patients sévères où l'expérience traumatique s'inscrit sur les plans sensoriels..

Este artículo tiene como objetivo investigar los procesos de comunicación subyacentes al lenguaje verbal que se presentan en la relación analítica. Analizaremos cómo el concepto de transferencia cambia en la literatura psicoanalítica, abriendo espacio a las dinámicas intersubjetivas presentes en el setting. En diálogo con la teoría del apego y sus fundamentos etológicos, presentaremos fenómenos borderlines, marcados por intensas manifestaciones corporales en el contexto de las relaciones interpersonales. A continuación, defenderemos la hipótesis de que existe en todo sujeto un núcleo inaccesible al habla, que aparece como material clínico principalmente en el análisis de pacientes críticamente enfermos, en que la experiencia traumática se inscribe en niveles sensoriales.

Estética e política: contribuições para a elaboração de casos clínicos em psicanálise / Aesthetics and politics: contributions to the elaboration of clinical cases in psychoanalysis / Estética y política: aportes a la elaboración de casos clínicos en psicoanálisis / Esthétique et politique: contributions à l'élaboration de cas cliniques en psychanalyse

Resumo Este artigo foi desenvolvido com o objetivo de pensar que a escrita de um caso clínico em psicanálise precisa considerar os elementos estéticos e políticos para se manter precisa em relação à ética da psicanálise. Para tanto, faremos aproximações entre o conceito de Inconsciente de Sigmund Freud e de Inconsciente Estético, proposto pelo filósofo francês Jacques Rancière. Assim, num primeiro momento será apresentado, de forma breve, o inconsciente estético e a psicanálise. Em um segundo momento, vamos apresentar os apontamentos de Rancière sobre estética e promover possíveis articulações entre o filósofo e Freud, a partir do que eles conceituam sobre o inconsciente. Finalmente, vamos pensar como o caso clínico pode ser observado a partir dessa ótica, investigando a respeito das articulações entre Inconsciente e Inconsciente Estético.

Abstract This article aims to think that the writing of a clinical case in psychoanalysis needs to consider the aesthetic and political elements to remain accurate regarding the ethics of psychoanalysis. To this end, we will make approximations between the concept of the Unconscious of Sigmund Freud and the Aesthetic Unconscious, proposed by the French philosopher Jacques Rancière. Thus, first we will present a brief presentation on the aesthetic unconscious and psychoanalysis. In a second moment, we will present Rancière's notes on aesthetics and promote possible articulations between the philosopher and Freud, from what they conceptualize about the unconscious. Finally, we will consider how the clinical case can be observed from this perspective that we propose, of investigating about the articulations between the Unconscious and the Aesthetic Unconscious.

Resumen Este artículo tiene por objetivo discutir que la escrita de un caso clínico en psicoanálisis necesita considerar los elementos estéticos y políticos para permanecer fiel a la ética del psicoanálisis. Para ello, se realizará una breve presentación sobre el concepto de inconsciente, de Sigmund Freud, y el inconsciente estético propuesto por Rancière. Primero, se presenta de forma breve el inconsciente estético y el psicoanálisis. Después, se expone los planteamientos de Rancière acerca de la estética y se hace posibles articulaciones entre el filósofo y Freud desde sus ideas sobre el inconsciente. Por último, se discutirá cómo se puede observar el caso clínico desde esta perspectiva que se propone investigar las posibles articulaciones entre el inconsciente y el inconsciente estético.

Résumé Cet article a le but de penser que l'écriture d'un cas clinique en psychanalyse doit tenir compte des éléments esthétiques et politiques pour rester juste par rapport à l'éthique de la psychanalyse. Dans ce but, nous ferons des approximations entre le concept d'Inconscient de Sigmund Freud et l'Inconscient Esthétique, proposé para the philosophe français Jacques Rancière. Donc, dans un premier temps, nous ferons un bref exposé sur l'inconscient esthétique et la psychanalyse. Deuxièmement, nous présenterons les notes de Rancière sur l'esthétique et nous soutiendrons les articulations possibles entre le philosophe et Freud, à partir de ce qu'ils conceptualisent sur l'inconscient. Enfin, nous réfléchirons comment le cas clinique peut être observé dans la perspective que nous proposons, d'étudier sur les articulations de l'Inconscient et l'Inconscient Esthétique.

O acúmulo de tarefas alheias ao ofício e o emergir de um gênero profissional invasivo / Accumulation of unrelated tasks and the emergence of an invasive professional genre

Este estudo aborda o fenômeno do acúmulo de tarefas em contexto da atividade de trabalho humana, a partir de operadores teóricos da clínica da atividade, como instâncias do ofício, estilo, gênero profissional, poder de agir e trabalho bem feito. Tomou-se como base material empírico referente a narrativas de trabalhadores participantes de pesquisa desenvolvida em um Serviço de Verificação de Óbitos (SVO), por meio de entrevistas semiestruturadas e de instrução ao sósia, realizadas com técnicos em necropsia. O referido material discursivo possibilitou o entendimento de que as submissões desses trabalhadores à tarefas alheias a seu ofício fizeram com que eles precisassem recorrer ao gênero profissional inerente a outros cargos, e dele se apropriar, originando o que aqui propõe-se denominar gênero profissional invasivo. Nesse sentido, o objetivo deste estudo foi estabelecer o diálogo entre o acúmulo de tarefas alheias ao ofício e um possível desenvolvimento do gênero profissional, em termos da produção de um gênero profissional invasivo

This study addresses the accumulation of tasks in the context of human work activity, based on theoretical operators from the clinic of activity, such as instances of professional practice, style, professional genre, power to act and work well-done. Analysis used empirical material related to narratives of workers participating in research developed in a Division of Postmortem Inspection (SVO), by means of semi-structured interviews and instruction to the double conducted with necropsy technicians. Results showed that the need to perform unrelated tasks made these workers appeal to the professional genre inherent to other jobs and appropriate it, giving rise to an invasive professional genre. Thus, the objective was to establish a dialogue between the accumulation of unrelated tasks and the possible development of a professional genre in terms of an invasive professional genre

Feminino, feminilidade e relação mãe-filha em psicanálise a partir da literatura de Elena Ferrante / Femenino, feminidad y relación madre-hija en psicoanálisis a partir de la literatura de Elena Ferrante / Feminine, femininity and mother-daughter relationship in psychoanalysis through the literature of Elena Ferrante / Féminin, féminité et relation mère-fille en psychanalyse à partir de la littérature d'Elena Ferrante

O presente artigo busca explorar a incidência da feminilidade (Weiblichkeit), a elaboração da sexualidade feminina (Weiblichsexualität) e a ambivalência afetiva nas relações primárias relação mãe e filha. Para tal, lançará mão das teorizações freudianas a partir da teoria da clínica psicanalítica e de uma interlocução com um romance da escritora italiana Elena Ferrante. Primeiramente, será trabalhada a lógica do inconsciente, assim como a pertinência da clínica e de possíveis incursões na literatura para apreensão de conceitos fundamentais da teoria psicanalítica. Em seguida, serão abordados marcadores mais precisos da constituição feminina, enfatizando a configuração afetiva que caracteriza o funcionamento pré-edípico. Ao longo destes desdobramentos, serão apresentados fragmentos da literatura mencionada que podem lançar luz sobre os impasses da relação mãe e filha, destacando o valor de aplicação clínica das passagens

Este artículo busca explorar la incidencia de la feminidad (Weiblichkeit), la elaboración de la sexualidad femenina (Weiblichsexualität) y la ambivalencia afectiva en las relaciones primarias madre-hija. Para ello, hará uso de teorías freudianas desde la teoría de la clínica psicoanalítica y una interlocución con un romance de la escritora italiana Elena Ferrante. Primero, se trabajará lalógica del inconsciente, así como la pertinencia de la clínica y de posibles incursiones en la literatura para la aprehensión de conceptos fundamentales de la teoría psicoanalítica. A continuación, se abordarán marcadores más precisos de la constitución femenina, enfatizando la configuración afectiva que caracteriza el funcionamiento preedípico. A lo largo de estos desarrollos, se presentarán fragmentos de la literatura mencionada que pueden arrojar luz sobre los impasses en la relación madre-hija, destacando el valor de aplicación clínica de los passajes

This article aims to explore the incidence of femininity (Weiblichkeit), the development of female sexuality (Weiblichsexualität), and the affective ambivalence in primary mother-daughter relationships. To do so, it will draw upon Freudian theories from the field of psychoanalytic clinical theory and engage with a novel by Italian writer Elena Ferrante. At first, the logic of the unconscious will be examined, as well as the relevance of clinical practice and possible forays into literature for grasping fundamental concepts of psychoanalytic theory. Subsequently, more precise markers of feminine constitution will be addressed, with emphasis on the affective configuration characterizing pre-Oedipal functioning. Throughout these unfoldings, literary fragments will be presented to shed light on the impasses within the mother-daughter relationship, highlighting the clinical application value of the passages

Cet article cherche à explorer l'incidence de la féminité (Weiblichkeit), l'élaboration de la sexualité féminine (Weiblichsexualität) et l'ambivalence affective dans les relations primaires mère-fille. À cette fin, il utilisera les théories freudiennes de la théorie de la clinique psychanalytique et une interlocution avec un roman de l'écrivaine italienne Elena Ferrante. Dans un premier temps, la logique de l'inconscient sera travaillée, ainsi que la pertinence de la clinique et de possibles incursions dans la littérature pour l'appréhension des concepts fondamentaux de la théorie psychanalytique. Ensuite, des marqueurs plus précis de la constitution féminine seront abordés, en insistant sur la configuration affective qui caractérise le fonctionnement pré-oedipien. Tout au long de ces développements, seront présentés des fragments de la littérature précitée pouvant éclairer les impasses de la relation mère-fille, mettre en évidence la valeur d'application clinique des passages

Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review. / Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

Las emergencias obstétricas son situaciones críticas que amenazan la salud de la madre y del bebé durante el embarazo o el parto. Este estudio se enfocó en validar la efectividad de la formación con simulación clínica en el manejo de estas situaciones. Realizamos una revisión narrativa de estudios publicados entre 2008 y 2022, recopilados de las bases de datos Scopus, ScienceDirect, MEDLINE/PubMed, Springer, SciELO y Google Scholar. Se recogieron y resumieron los datos de los estudios que cumplían con nuestros criterios de inclusión. Nuestros resultados subrayan que la simulación clínica se posiciona como una herramienta altamente eficaz en la formación de profesionales de la salud. Esta capacitación se traduce en mejoras significativas en diversos aspectos, incluyendo el rendimiento, los conocimientos, la confianza, la satisfacción, las actitudes, la autoeficacia, la capacidad para trabajar en equipo y las habilidades necesarias para enfrentar situaciones obstétricas críticas. Dentro de estas últimas destacan hemorragias posparto, eclampsia, distocia de hombros, paro cardíaco materno, prolapso del cordón umbilical y cesáreas. Esta formación disminuye los riesgos asociados con el aprendizaje en pacientes reales y cumple con los estándares éticos. La colaboración interdisciplinaria en el manejo de emergencias obstétricas se revela efectiva para brindar atención integral a los pacientes. Sin embargo, es fundamental enfatizar que para asegurar la seguridad del paciente y promover un enfoque de trabajo en equipo, es esencial que los profesionales de la salud reciban una formación adecuada y estén debidamente cualificados. A pesar de que la formación en simulación clínica es eficaz, su implementación puede resultar costosa y requerir recursos considerables. No obstante, consideramos que esta estrategia sigue siendo de un valor incalculable para la formación de profesionales en este campo. Investigaciones futuras de alta calidad contribuirán a fortalecer la evidencia sobre las mejores prácticas en la formación con simulación clínica en emergencias obstétricas.

Formación con simulación clínica para manejo adecuado de emergencias obstétricas: revisión narrativa / Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review

Las emergencias obstétricas son situaciones críticas que amenazan la salud de la madre y del bebé durante el embarazo o el parto. Este estudio se enfocó en validar la efectividad de la formación con simulación clínica en el manejo de estas situaciones. Realizamos una revisión narrativa de estudios publicados entre 2008 y 2022, recopilados de las bases de datos Scopus, ScienceDirect, MEDLINE/PubMed, Springer, SciELO y Google Scholar. Se recogieron y resumieron los datos de los estudios que cumplían con nuestros criterios de inclusión. Nuestros resultados subrayan que la simulación clínica se posiciona como una herramienta altamente eficaz en la formación de profesionales de la salud. Esta capacitación se traduce en mejoras significativas en diversos aspectos, incluyendo el rendimiento, los conocimientos, la confianza, la satisfacción, las actitudes, la autoeficacia, la capacidad para trabajar en equipo y las habilidades necesarias para enfrentar situaciones obstétricas críticas. Dentro de estas últimas destacan hemorragias posparto, eclampsia, distocia de hombros, paro cardíaco materno, prolapso del cordón umbilical y cesáreas. Esta formación disminuye los riesgos asociados con el aprendizaje en pacientes reales y cumple con los estándares éticos. La colaboración interdisciplinaria en el manejo de emergencias obstétricas se revela efectiva para brindar atención integral a los pacientes. Sin embargo, es fundamental enfatizar que para asegurar la seguridad del paciente y promover un enfoque de trabajo en equipo, es esencial que los profesionales de la salud reciban una formación adecuada y estén debidamente cualificados. A pesar de que la formación en simulación clínica es eficaz, su implementación puede resultar costosa y requerir recursos considerables. No obstante, consideramos que esta estrategia sigue siendo de un valor incalculable para la formación de profesionales en este campo. Investigaciones futuras de alta calidad contribuirán a fortalecer la evidencia sobre las mejores prácticas en la formación con simulación clínica en emergencias obstétricas.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.