Shifts of SARS-CoV-2 exposure settings in the transmission clusters of 2 epidemic waves in Hong Kong.

Exposure setting is crucial in the formation and propagation of SARS-CoV-2 transmission clusters. In this cohort study, transmission networks of 2 waves were differentiated by exposure setting using territory-wide surveillance data with clinical and laboratory records in Hong Kong. Characteristically, the first wave had resulted from imported cases followed by local transmissions, while the second wave was constituted primarily by local infections. With a 4-fold higher caseload, the second wave featured predominance of epidemiologically linked, local, older and asymptomatic patients with higher viral loads and shorter inpatient days. The 1028 transmission clusters formed 155 cascades composing at least two clusters. Daily and social activities were exposure settings that bridged clusters while residences usually terminated transmission cascades. Regulatory restrictions on social activities extinguished cluster formation in bars, but shifted to private parties in the second wave. The results confirmed that strategic interventions targeting exposure settings could achieve effective epidemic control.

A conformidade jurídica das penalidades impostas por sociedades médicas de especialidades / The legal compliance of penalties imposed by specialty medical societies

Introdução: O estudo doravante desenvolvido propõe analisar as penalidades impostas por Sociedades de Especialidades Médicas, entidades organizadas sob a forma de associações civis, sobretudo se configuram usurpação legal de competência dos Conselhos Profissionais. Será investigada a natureza dessas punições e seus efeitos e alcances, no intuito de verificar se há efetivo prejuízo ao exercício profissional da medicina pelo galeno. Métodos: Para a referida análise, foram levantadas as normas aplicáveis dentro ordenamento jurídico brasileiro, sua sistematização e conflitos aparentes, a fim de situar as punições associativas e sua conformidade com a ordem jurídica vigente. Resultados/Conclusão: Verificou-se do estudo que não há qualquer óbice à aplicação de tal modalidade de sanções, uma vez respeitadas as garantias legais e constitucionais da ampla defesa, contraditório e devido processo legal.

Introduction: The study developed hereafter proposes to analyze the penalties imposed by Societies of Medical Specialties, entities organized in the form of civil associations, specially if they constitute legal usurpation of the competence of Professional Councils. The nature of these punishments and their effects and scope will be investigated, in order to verify whether there is effective damage to the professional practice of medicine by physicians. Methods: For this analysis, the applicable rules within the Brazilian legal system were raised, their systematization and apparent conflicts, in order to locate the associative punishments and their compliance with the current legal order. Results/Conclusion: It was verified from the study that there is no obstacle to the application of this type of sanctions, once the legal and constitutional guarantees of ample defense, contradictory and due process are respected.

Desafios no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do SUS / Challenges in the methodological path of building the Institutional Accreditation process for SUS ombudpersons

RESUMO O artigo buscou refletir sobre os desafios teórico-práticos enfrentados no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do Sistema Único de Saúde (SUS), na elaboração dos materiais pedagógicos e nas dinâmicas de interações fundamentais entre os atores envolvidos. Discorre-se sobre a trajetória de uma parceria de trabalho entre uma equipe de pesquisadores e um departamento do Ministério da Saúde, que visa apoiar teórico-metodologicamente as ações do setor trabalhando os grandes temas da participação e do controle social e, em particular, das ouvidorias, gerando evidências para a tomada de decisões da gestão. São apresentados e problematizados desafios enfrentados no caminho da parceria e do processo de um ponto de vista metodológico, reflexivo e participativo, apresentando-se ideias, noções e conceitos que sofreram evolução, e que presidem os materiais pedagógicos elaborados para instrumentalização do processo de Acreditação Institucional de ouvidorias do SUS enquanto balizamento teórico-prático. Conclui-se que a adoção de um desafiador método de trabalho construtivista e participativo representa um salutar esforço pelo autoaperfeiçoamento e pela garantia da afirmação de valores e princípios democráticos, efetivos na busca constante pela qualificação das ações das ouvidorias, da própria atividade de pesquisa, da prática da gestão e dos serviços e políticas públicas.

ABSTRACT This paper aims to reflect on the theoretical and practical challenges in the methodological path of building the Institutional Accreditation process of the Unified Health System (SUS) ombudspersons, developing teaching materials, and the dynamics of fundamental interactions between the stakeholders involved. It discusses the trajectory of a working partnership between a team of researchers and a department of the Ministry of Health, which aims to theoretically and methodologically support the actions of the sector working on the principal participation and social control topics and, in particular, the ombudspersons, generating evidence for management decision-making. The authors present the challenges in partnership and the process and discuss from a methodological, reflective, and participatory viewpoint, presenting ideas and concepts that have evolved and govern the pedagogical materials prepared for the instrumentalization of the Institutional Accreditation process of SUS ombudspersons as a theoretical-practical framework. The authors conclude that adopting a challenging constructivist method is a healthy effort for self-improvement and guarantee of the affirmation of democratic values, effective in the constant search for the qualification of the actions of the ombudspersons, research activity, management practice, and services and public policies.

Temáticas editoriais da Revista Acta Paulista de Enfermagem: um estudo bibliométrico (1988-2017) / Temáticas editoriales de la Revista Acta Paulista de Enfermería: un estudio bibliométrico (1988-2017) / Editorial themes of the Acta Paulista de Enfermagem journal: a bibliometric study (1988-2017)

Resumo Objetivo Analisar as temáticas editoriais publicadas na Revista Acta Paulista de Enfermagem ao longo de seus primeiros trinta anos de existência. Métodos Pesquisa bibliométrica dos editoriais publicados entre 1988 e 2017, com o uso dos Descritores em Saúde, com análise quanti-qualitativa de termos específicos e categorias, discutidas sob a ótica da genealogia do saber de Michel Foucault. Resultados Foram coletados 129 editoriais, 389 termos padronizados e 706 categorias. Os termos específicos mais frequentes resultaram na tríade de tendência temática em (1) Editoração / Publicação Periódica, (2) Pesquisa e (3) Capacitação / Especialidade. Por sua vez, as categorias apontaram a tendência temática em Saúde Pública. Conclusão Os termos e categorias transmitiram ideias de base política de valorização da Enfermagem, evento que coincidiu com a trajetória de luta pelo desenvolvimento do sistema de saúde universal. Essa interligação social demonstra que a visão panóptica dos editoriais foi além de suas funções acadêmicas e científicas.

Resumen Objetivo Analizar las temáticas editoriales publicadas en la Revista Acta Paulista de Enfermería a lo largo de sus primeros treinta años de existencia. Métodos Investigación bibliométrica de los editoriales publicados entre 1988 y 2017, con el uso de los Descriptores en Salud, con un análisis cuali-cuantitativo de términos específicos y de categorías, discutidas bajo la óptica de la genealogía del saber de Michel Foucault. Resultados Se recopilaron 129 editoriales, 389 términos estandarizados y 706 categorías para términos específicos más frecuentes resultaron en la tríada de tendencia temática en (1) Edición / Publicación Periódica, (2) Investigación y (3) Capacitación / Especialidad. Por su lado las categorías señalaron la tendencia temática en Salud Pública. Conclusión Los términos y categorías transmitieron ideas de base política de valoración de la Enfermería, evento que coincidió con la trayectoria de lucha por el desarrollo del sistema de salud universal. Esa interconexión social demuestra que la visión panóptica de los editoriales fue más allá de sus funciones académicas y científicas.

Abstract Objective To analyze the editorial themes published in the Acta Paulista de Enfermagem journal throughout its first thirty years of existence. Methods Bibliometric study of editorials published between 1988 and 2017 using Health Descriptors and quantitative and qualitative analysis of specific terms and categories discussed from the perspective of Michel Foucault's genealogy of knowledge. Results In total, 129 editorials, 389 standardized terms and 706 categories were collected. The most frequent specific terms resulted in the triad of thematic trend in (1) Editing/Periodic publication, (2) Research and (3) Training/Specialty. In turn, the categories indicated the thematic trend in Public Health. Conclusion The terms and categories conveyed politically based ideas of valuing Nursing, an event that coincided with the struggle for the development of the National Health Service. This social interconnection demonstrates that the panoptic vision of editorials went beyond their academic and scientific functions.

Challenges in the methodological path of building the Institutional Accreditation process for SUS ombudsmen / Desafios no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do SUS

The article seeks to reflect on the theoretical and practical challenges faced in the methodological path of construction of the Institutional Accreditation process of SUS ombudsmen, as well as in the development of teaching materials and the dynamics of fundamental interactions between the actors involved. It discusses the trajectory of a working partnership between a team of researchers and a department of the Ministry of Health, which aims to theoretically and methodologically support the actions of the sector working on the major themes of participation and social control and, in particular, the ombudsmen, generating evidence for management decision-making. Challenges faced in the path of partnership and the process are presented and discussed from a methodological, reflective and participatory point of view, presenting ideas and concepts that have undergone evolution, and which govern the pedagogical materials prepared for the instrumentalization of the rocess as a theoretical-practical framework. It is concluded that the adoption of a challenging constructivist method represents a healthy effort for self-improvement and for guaranteeing the affirmation of democratic values, effective in the constant search for the qualification of the actions of the ombudsmen, of the research activity itself, of the practice of management and services and public policies.

O artigo busca refletir sobre os desafios teórico-práticos enfrentados no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do SUS, bem como na elaboração dos materiais pedaógicos e nas dinâmicas de interações fundamentais entre os atores envolvidos. Discorre-se sobre a trajetória de uma parceria de trabalho entre uma equipe de pesquisadores e um departamento do Ministério da Saúde, que visa apoiar teórico-metodologicamente as ações do setor trabalhando os grandes temas da participação e do controle social e, em particular, das ouvidorias, gerando evidências para a tomada de decisões da gestão. São apresentados e problematizados desafios enfrentados no caminho da parceria e do processo de um ponto de vista metodológico, reflexivo e participativo, apresentando-se ideias, noções e conceitos que sofreram evolução, e que presidem os materiais pedagógicos elaborados para instrumentalização do processo de Acreditação Institucional de ouvidorias do SUS enquanto balizamento teórico-prático. Conclui-se que a adoção de um desafiador método de trabalho construtivista e participativo representa um salutar esforço pelo autoaperfeiçoamento e pela garantia da afirmação de valores e princípios democráticos, efetivos na busca constante pela qualificação das ações das ouvidorias, da própria atividade de pesquisa, da prática da gestão e dos serviços e políticas públicas.

O auto do [consenso] de Viena: Estratégias de legitimação no Sistema Internacional de Controle de Drogas / The Tale of the Vienna [Concensus]: legitimation Strategies in the International Drug Control System

As drogas foram construídas como um problema mundial por organismos internacionais, responsáveis pela elaboração de normativas com a finalidade de combater seu consumo, cultivo e comércio, enquanto interpreto esse fenômeno como um problema público, criado a partir da universalização de algo tão específico quanto a compreensão segundo a qual elas devem ser usadas para fins médicos e científicos. Esta visão de mundo mobiliza grandes estruturas burocráticas e moralizantes onde agentes engendram esforços para disputar a hegemonia no Sistema Internacional de Controle de Drogas que, por sua vez, é organizado pela Organização das Nações Unidas. Seus Estados-Membros disputam a hegemonia de um campo que viu seu balizador se quebrar recentemente, qual seja, o Consenso de Viena, o entendimento de que a demanda por drogas deve ser extinta. Mas, na Década da Gestão do Dissenso (2009-2019), o principal argumento, tanto dos agentes hegemônicos, quanto daqueles contra-hegemônicos, persistiu: deve-se proteger a saúde. Com o objetivo de identificar e compreender as estratégias de legitimação adotadas durante a 62ª Sessão da Comissão de Drogas Narcóticas (2019), empregamos uma metodologia que conjugou etnografia de eventos e de documentos, observação participante e realização de entrevistas semiestruturadas. Foram delineadas 15 estratégias, acionadas num contexto de árdua batalha entre delegações de todos os continentes por categorias referentes à Redução de Danos e aos Direitos Humanos, como "atitudes não estigmatizantes" e "mulheres que usam drogas". Esperamos colaborar para debates institucionais em escala global e local mais permeáveis às contribuições das Ciências Sociais e Humanas em Saúde, fortalecendo uma ciência capaz de reformular radicalmente a política de drogas

Drugs were constructed as a global problem by international bodies, responsible for drafting regulations in order to combat their consumption, cultivation and trade, while I interpret this phenomenon as a public problem, created from the universalization of something as specific as understanding that they should be used for medical and scientific purposes. This worldview mobilizes large bureaucratic and moralizing structures where agents engender efforts to dispute hegemony in the International Drug Control System, which, in turn, is organized by the United Nations. Its Member States are vying for the hegemony of a field that has recently seen its beacon broken, namely the Vienna Consensus, the understanding that the demand for drugs should be extinguished. But, in the Decade of Dissent Management (2009-2019), the main argument, from both hegemonic agents and those against hegemonic ones, persisted: health must be protected. In order to identify and understand the legitimation strategies adopted during the 62nd Session of the Commission on Narcotic Drugs (2019), we used a methodology that combined ethnography of events and documents, participant observation and semi-structured interviews. Fifteen strategies were outlined, triggered in a context of an uphill battle between delegations from all continents for categories related to Harm Reduction and Human Rights, such as "non-stigmatizing attitudes" and "women who use drugs". We hope to contribute to institutional debates on a global and local scale that are more permeable to the contributions of the Social and Human Sciences in Health, strengthening a science capable of radically reshaping drug policy.

Na arena do Poder: as indicações para cargos diretivos nas agências reguladoras no Brasil - a experiência da ANVISA (1999-2019) / In the arena of Power: director nominations in Brazilian regulatory agencies - Anvisa's experience (1999-2019)

Esta tese analisa as indicações dos diretores para compor a diretoria colegiada da Anvisa e a política regulatória sanitária assumida a partir de tais indicações. O referencial teórico envolveu as teorias da regulação e o neoinstitucionalismo histórico. O período escolhido para análise foi o compreendido entre 1999 e 2019, quando se completaram os 20 anos da Anvisa. O escopo deste trabalho incorporou aspectos sobre o sistema político brasileiro, assim como breve descrição sobre a percepção dos governos dos presidentes da República envolvidos com a nomeação de diretores para a Anvisa. Foi realizado um estudo de caráter exploratório e retrospectivo, baseado em abordagem quali-quantitativa, utilizando múltiplas fontes de dados. Uma das facetas deste estudo, envolveu estudar o perfil dos diretores nomeados para compor a diretoria colegiada da Anvisa, a trajetória pré e pós assumir o cargo de diretor na Anvisa, as filiações partidárias e os parlamentares envolvidos nas suas nomeações, buscando identificar características nesses dirigentes que comprometessem ou não, a condução da Agência dentro dos seus princípios institucionais. Além de uma etapa de pesquisa documental nos regimentos internos da Anvisa e a última etapa de estudo de caso. A análise levou em consideração os elementos importantes da abordagem teórica utilizada, buscando identificar os atores, na diretoria da Anvisa, que se mostraram estratégicos durante a implementação ou não dos atos legais. Entre os principais resultados da análise do perfil dos diretores, destacam-se que 100% eram oriundos do setor público em atividade imediatamente anterior ao ingresso como diretor da Anvisa. No entanto, uma parcela migrou para o setor regulado após o cumprimento do seu mandato. Cerca de 43% dos indicados possuíam filiação partidária anterior à nomeação. Observou-se que o desenho institucional das agências reguladoras é constantemente confrontado com o sistema político brasileiro e os grupos de pressão. Por vezes, foi possível identificar uma agenda política nos diretores da Agência ao assumir sua função institucional, confrontando políticas de governo com políticas de Estado. Apesar do ano de 2020 não compor este estudo, a pandemia pelo novo coronavírus, evidenciou para a população brasileira, os conflitos e as pressões sofridas pela Anvisa ao longo de sua existência.

This dissertation analyzes the director nominations for the collegiate directory at Anvisa and the sanitary regulation policy involved. Theories of regulation and historical neo-institutionalism were used as reference. The period selected for this analysis is between 1999 and 2019, when Anvisa completed 20 years. The scope of this research involved aspects of the Brazilian political system, as well as a brief description of the administration of the presidents when nominating directors for Anvisa. An exploratory and retrospective study was done based on a qualitative and quantitative approach and using multiple data sources. One of the sections of this research involved studying the profile of the nominated directors that composed the collegiate directory at Anvisa, their career paths before and after assuming the position, their political party affiliations and the politicians involved in their nominations, aiming to identify in these candidates characteristics that could compromise their role in the agency within its institutional principles. Another section involves the document research of the Anvisa's internal policies, as well as a specific section for case studies. The analysis considered the important elements of the selected theoretical approaches, with the intention of identifying strategic actors in Anvisa's directory during the implementation or not of legal actions. While analyzing the main results of the directors' profile, it was found that 100% of the directors were acting in the public sector immediately prior to becoming Anvisa's director. However, a portion of them migrated to the regulated sector after fulfilling their mandate. About 43% of the nominees had political party affiliations prior to their nomination. It was found that the institutional design of the regulating agencies is constantly confronted with the Brazilian political system and pressure groups. Oftentimes, it was possible to identify a political agenda in the directors at Anvisa when assuming the institutional role, confronting government policies and national policies. Although the year of 2020 is not in the scope of this study, the coronavirus pandemic made it evident to the Brazilian public the conflicts and pressures in Anvisa throughout its existence.

Controle social do programa de alimentação escolar em um município de grande porte / Control of the school feeding program in a large municipality

Analisar o perfil de atuação do Conselho de Alimentação Escolar (CAE) de um município de grande porte do Estado do Rio de Janeiro. Trata-se de pesquisa qualitativa de análise documental de normativas federais e das atas públicas das reuniões do CAE durante o mandato de 2013 a 2016. A coleta de documentos foi realizada no sítio eletrônico do Ministério da Educação e no sítio eletrônico oficial da prefeitura do município estudado. Verificou-se tendência temporal nos documentos do governo federal de reforçar o papel fiscalizador do CAE, e a análise das atas do município apontou convergência com essa concepção fiscalizadora, focada nos processos burocráticos do recurso, prestação de contas, comunicação de irregularidades aos órgãos de controle e emissão de relatórios. Que o perfil de atuação do CAE é moldado pela concepção que predomina nos marcos legais, se destacando como fiscalizador e majoritariamente técnico.

To analyze the performance profile of the School Feeding Council (CAE) of a large municipality in the state of Rio de Janeiro. This is qualitative research of documentary analysis of federal regulations and of the public documents of the CAE meetings during the mandate from 2013 to 2016. The search of the norms of the School Feeding National (PNAE) was carried out on the website of the Ministry of Education, on the official website of the city council of the selected city. We can analyze that there seems to be a time tendency in federal government documents to strengthen the CAE oversight role and the analysis of the documents of the city points to convergence with this oversight conception of the CAE, focused on the bureaucratic processes of the resource, reporting irregularities to the control and reporting bodies, although participation movements in training events. The CAE's performance profile is shaped by the concept that prevails in the legal frameworks, standing out as supervisory and mostly technical.

Participação social em saúde: limites e potencialidade de conselhos locais de saúde de uma metrópole brasileira / Health social participation: limits and potentialities of local health councils in a Brazilian metropolis / Participación social en salud: límites y potencialidades de los consejos locales de salud de una metrópoli brasileña

Este estudo objetiva analisar os motivos associados à participação de usuários em Conselhos Locais de Saúde (CLS) de Porto Alegre, Rio Grande do Sul, por meio de uma pesquisa exploratória de abordagem qualitativa. Foram realizadas entrevistas semiestruturadas e individuais com 14 usuários, conselheiros ou não, associados a seis Unidades de Saúde. O corpus foi tratado a partir da análise de conteúdo. Ao final, foram identificados fatores que dificultam a participação social, como problemas na comunicação, descrédito sobre impacto de conselhos, falta de infraestrutura adequada, horário das reuniões e situações de violência. Paralelo a isso, também verificaram-se aspectos que facilitam a participação, entre eles: contato com trabalhadoras(es) de saúde, posicionamento ético-político, projetos com comunidade e proatividade. Concluiu-se que fatores impeditivos e facilitadores à participação social pertencem a um mesmo conjunto de problemas e estão interligados, complexificando a situação e colocando em questão a própria participação.

This study analyzes the reasons associated with the participation of users in Local Health Councils (LHC) of Porto Alegre, Rio Grande do Sul, Brazil, by means of a qualitative and exploratory research. Semi-structured, individual interviews were carried out with 14 users, counselors or not, assigned to six Health Units. Data was treated using Content Analysis. In the end, the analysis identified six factors that hinder social participation: communication issues, lack of belief in the councils, lack of adequate infrastructure, meeting times, and situations of violence. Conversely, the factors that facilitate participation were mainly: contact with health workers, ethical-political standing, community projects, and proactivity. In conclusion, impeditive and facilitating factors to social participation belong to the same set of issues and are interconnected, complexifying the situation and putting into question participation itself.

Este estudio pretende analizar los motivos asociados a la participación de usuarios en Consejos locales de salud (CLS) de Porto Alegre, en Rio Grande do Sul (Brasil), con base en una investigación exploratoria de abordaje cualitativo. Se realizaron entrevistas semiestructuradas individuales con catorce usuarios, consejeros o no, adscritos a seis Unidades de Salud. El corpus fue tratado con la ayuda del análisis de contenido. Los resultados identificaron los factores que dificultan la participación social, como problemas de comunicación, descrédito en el impacto de los consejos, falta de una adecuada infraestructura, horario de las reuniones y situaciones de violencia. Paralelo a eso, existen factores para facilitar la participación: contacto con los/las trabajadores/as de salud, postura ético-política, proyectos con la comunidad y proactividad. Se concluye que los factores impeditivos y facilitadores en lo que se refiere a la participación social pertenecen a un mismo conjunto de problemas y están interconectados, complejizando la situación y poniendo en cuestión la propia participación.

Efetividade da participação de um conselho municipal de saúde na região Sul do Brasil / Effectiveness of participation of a municipal health council in the Brazilian South region

RESUMO Este estudo tem como propósito avaliar a efetividade da participação social em um conselho municipal de saúde, com o intuito de produzir informações que contribuam para o aprimoramento da democracia deliberativa. Trata-se de um estudo de caso, de abordagem qualitativa, sobre o Conselho Municipal de Saúde de Criciúma (SC), com utilização de entrevistas semiestruturadas e análise documental. Os dados organizados e sistematizados resultaram em duas categorias temáticas, quais sejam: empowerment e decisão. Usualmente, os membros que estão na primeira gestão e, por conseguinte, ainda não foram capacitados, detêm menos conhecimento a respeito do seu papel como conselheiros, quando comparados com os conselheiros mais antigos na instituição, salientando que, quando as práticas educativas são empregadas adequadamente, podem minimizar as assimetrias que permeiam a atuação dos conselheiros de saúde para atingir níveis desejáveis de influência desses atores no controle público. Ademais, os conselheiros apresentaram uma positiva atuação, incentivando a participação da comunidade e impactando sobre o acesso e a qualidade dos serviços de saúde, alavancando resultados práticos e progressos de acordo com as necessidades locais elencadas pela população. Neste cenário, evidencia-se a importância de informar e conscientizar os conselheiros, a fim de ampliar seus conhecimentos políticos, éticos e teóricos.

ABTRACT This study aims to evaluate the effectiveness of social participation in a municipal health council, with the purpose of producing informations that contribute to the improvement of deliberative democracy. This is a case study, with a qualitative approach, on the Municipal Health Council of Criciúma (SC), using semi-structured interviews and documentary analysis. The data organized and systematized resulted in two thematic categories, namely: empowerment and decision. Usually, the members who are in the first management and, therefore, have not yet been trained, have less knowledge about their role as counselors, when compared with the older counselors in the institution, noting that, when educational practices are employed appropriately, can minimize the asymmetries that permeate the performance of health counselors and achieve desirable levels of influence of these actors in public control. In addition, the members presented a positive performance, encouraging community participation and impact on access and quality of health services, leveraging practical results and progress according to the local needs highlighted by the population. In this scenario, it is evident the importance of informing and raising the awareness of the counselors, in order to broaden their political, ethical and theoretical knowledge.

Análisis del aborto desde un punto de vista conceptual / Abortion Analysis From a Conceptual Point of View / Análise do Abordo do Ponto de Vista Conceitual

Resumen El aborto se sitúa como uno de los más graves atentados contra la solidaridad intergeneracional porque ataca directamente la filiación. La diacronía establece el amparo del más débil y el amor entre padres e hijos. Esto se rompe desde las amenazas a la figura del hijo. Este artículo se desarrolla en el plano de los conceptos y la necesidad de contribuir a la vida en la sociedad actual. Para ello es necesario incidir en la dignidad de la vida humana en aquellos círculos académicos y de debate intelectual desde donde se crean las distintas corrientes de opinión.

Abstract Abortion is one of the most serious attacks against intergenerational solidarity because it directly attacks filiation. The diachrony establishes the protection of the weakest and the love between parents and children. This is broken from the attacks on the figure of the child. This paper moves in the concepts and the need to contribute in favor of life in today's society. For this, it is necessary to influence in favor of the dignity of human life in the academic and debate circles, spaces in which the different currents of opinion are created.

Resumo O aborto posiciona-se como um dos mais graves atentados contra a solidariedade intergeracional, porque ataca diretamente a filiação. A diacronia estabelece o amparo do mais fraco e o amor entre pais e filhos. Isso se quebra a partir das ameaças à figura do filho. Este artigo se desenvolve no plano dos conceitos e da necessidade de contribuir para a vida na sociedade atual. Para isso, é necessário incidir na dignidade da vida humana nos círculos acadêmicos e de debate intelectual, contextos em que são criadas as diferentes correntes de opinião.

Broad support for regulating the clinical implementation of future reproductive techniques.

STUDY QUESTION: Do gynaecologists, infertile patients and the general public, consider that regulation of the clinical implementation of stem cell-based fertility treatments is required? SUMMARY ANSWER: There is broad support from gynaecologists, patients and the general public for regulating the clinical implementation of future stem cell-based fertility treatments. WHAT IS KNOWN ALREADY: There is debate on the need to regulate the clinical implementation of novel techniques. Regulation may hinder their swift adoption and delay benefits for patients, but may prevent the implementation of ineffective or harmful techniques. Stem cell-based fertility treatments, which involve creating oocytes or spermatozoa by manipulating stem cells, are likely to be implemented in clinical practice in the near future and will probably impact future generations as well as the current one. STUDY DESIGN, SIZE, DURATION: A cross-sectional survey was conducted among gynaecologists working in fertility clinics (n = 179), patients with severe infertility (n = 348) and a representative sample of the general public (n = 1250). The questionnaire was disseminated in the Netherlands in the winter of 2015-2016. PARTICIPANTS/MATERIALS, SETTING, METHODS: The newly developed questionnaire was reviewed by experts and tested among the general public. The questionnaire assessed whether participants wanted each of nine potential negative consequences of the clinical implementation of stem cell-based fertility treatments to be regulated. In addition, the importance of all negative and positive potential consequences, the appropriate regulatory body and its need to consult with advisors from various backgrounds was questioned. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 958 respondents completed the questionnaire (response rate: 54%). A large majority of each participant group (>85%) wanted regulation, for at least one potential negative consequence of the clinical implementation of stem cell-based fertility treatments. The majority of all participant groups wanted regulation for serious health risks for intended parents, serious health risks for children and the disposal of human embryos. Regulation for out-of-pocket costs and the burden of treatment received little support. The majority of gynaecologists and the general public, but not the patients, requested regulation for the risk of minor congenital abnormalities, the success rates and the naturalness of treatments. Nevertheless, the majority of patients did consider the former two potential negative consequences important. The majority of all groups preferred a national bioethics committee as the regulatory body. This committee should consult with advisors from various backgrounds and should consider the broader context of potential consequences of the stem cell-based fertility treatments. LIMITATIONS, REASONS FOR CAUTION: This empirical study focuses on only three stakeholder groups. This study reports on the perspective of the majority and this is not per definition the morally right perspective. The transferability of our findings to other cultures and other techniques remains unclear. WIDER IMPLICATIONS OF THE FINDINGS: A national bioethics committee, consulting with advisors from various backgrounds, should regulate the clinical implementation of future stem cell-based fertility treatments. Whether this broad support for regulation applies to novel techniques from other fields of medicine should be examined. STUDY FUNDING/COMPETING INTEREST(S): The Young Academy of the Royal Netherlands Academy of Arts and Sciences. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER: Not applicable.

Demanda de políticas regulatórias para o exercício profissional da odontologia no âmbito do Mercosul / Demand for regulatory policies for the professional practice of dentistry within Mercosur

RESUMO O artigo tem como objetivo analisar marcos regulatórios da profissão de odontologia no Brasil, com vistas à livre circulação de serviços e pessoas no Mercosul. A partir da revisão de literatura e da observação participante, conclui-se que existe uma assimetria entre os processos de regulação do exercício profissional dos odontólogos entre os Estados Partes, havendo o risco dessa liberalização gerar efeitos adversos ao mercado de trabalho odontológico brasileiro, quando da ausência de políticas regulatórias para o livre trânsito dessa categoria. Ademais, atuando para colaborar para esse processo, foi constituído o Fórum Permanente do Mercosul para o Trabalho em Saúde que tem entre as suas contribuições a construção da Matriz Mínima de Registro de Profissionais de Saúde do Mercosul. Às considerações finais, elencaram-se sugestões para o deslindar dos entraves à integração, considerando que o aprofundamento delas é desejável aos olhos governamentais e que se faz premente a harmonização de legislações e a eleição de marcos regulatórios direcionados ao tema.(AU)

ABSTRACT The article aims to analyze regulatory frameworks of the dentistry profession in Brazil, with a view to the free movement of services and people in Mercosur. From literature review and participant observation, we conclude that there is an asymmetry between the processes of regulation of the professional practice of dentists among the States Parties, with the risk of that liberalization generating adverse effects on the Brazilian dental job market, in the absence of regulatory policies for free movement of this category. Furthermore, working to collaborate with that process, the Mercosur Permanent Forum for Health Work was constituted, which has among its contributions the construction of the Minimum Matrix of Registration of Health Professionals of Mercosur. To the final considerations, we make suggestions for the removal of barriers to integration, considering it's deepening is desirable for government eyes and that the harmonization of legislation and the choice of regulatory frameworks directed to the issue are imperious.(AU)

Exploring and explaining involuntary care: The relationship between psychiatric admission status, gender and other demographic and clinical variables.

Involuntary admission and treatment are features of psychiatric care in many countries, but the relationship between involuntary status and gender (among other factors) is not clear. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in a deprived area of Dublin's north inner-city over a 7-year period (2008 to 2014 inclusive). Over this period, there were 1099 admissions, yielding an annual admission rate of 504.8 admissions per 100,000 population per year. When adjusted for deprivation, this rate (387.7) was lower than the national rate (413.9). Consistent with other inner-city areas in Dublin, 14.1% of admissions were involuntary, yielding an involuntary admission rate of 71.2 per 100,000 population per year (deprivation-adjusted rate: 54.8), which is higher than the national rate (39.4). After controlling for age, occupation, marital status and diagnosis, the only independent predictors of admission status were place of origin (p<0.001) and male gender (p=0.001). These findings are consistent with studies showing associations between male gender and involuntary status in the United States, New Zealand, Netherlands, Norway, Belgium, France, and Luxembourg. In contrast, female gender is associated with involuntary status in Switzerland, Brazil, and China. These cross-national differences are likely related to differing legal traditions and different criteria for involuntary admission, possibly related to varying emphases placed on "dangerousness" as a mandatory criterion for involuntary hospitalization. This merits further, cross-national study.

Identidad e institucionalidad de las enfermeras chilenas en la mitad del siglo XX / Identity and institutional framework of chilean nurses in the mid-twentieth century

Chile vivência durante las décadas de los 70 y 80 del siglo XX un giro total en la política, vida social y en la economía de la nación, lo que provocó cambios profundos en los actores sociales del país. Para esta investigación el actor social observado fueron las enfermeras, siendo el objetivo que guió esta trayectoria el describir y conectar el relato histórico de la enfermera chilena con las narrativas individuales, otorgando un relato identitario de la enfermera chilena antes de los años 70 del siglo XX en Chile. Método: El paradigma de investigación utilizado fue el constructivista, guiado por el método historiográfico cuya interpretación fue guiado por Claude Dubar, se utilizó fuentes secundarias escritas y relatos de vida. Resultados: El contexto de la profesionalización de la enfermera en Chile y el relato e identidad de las enfermeras durante el periodo anterior a los años 70. Conclusión: Es posible señalar que la identidad de las enfermeras antes de la década de los 70 se caracterizó por la socialización de su identidad al interior de los espacios institucionales, posteriormente su acción definitoria fue el reconocimiento de la urgencia en la intervención de salud, esto dado las condiciones de vida precarias de la población, por ello su acción se vuelve hacia la satisfacción de las necesidades vitales como la protección de la madre y el recién nacido. Finalmente el último proceso de socialización es el desarrollo de instituciones propias que la instala en el espacio público chileno, formando así una identidad comunitaria.

During the 70s and 80s Chile experienced a radical change in politics, social life and economy, causing profound changes in the country's social actors. For this research the social actor observed was nurses, with the aim of describing and connecting the historical record of the Chilean nurse with individual narratives, thus giving an identity account of the Chilean nurse before the 70s of XX century in Chile. Method: The research paradigm used was Constructivism, guided by the historiographical method, whose interpretation was guided by Claude Dubar; life stories and written records of secondary sources were also used. Results: What was obtained is the context surrounding the professionalization process of nurses in Chile as well as the stories and identity of nurses during the period prior to the 70s. Conclusion: It is possible to indicate that the identity of nurses before the 70s was characterized by the socialization of such identity within institutional spaces, then its defining action was given by the recognition of the urgency in the health intervention due to the precarious living conditions of the population; therefore, their action turns to the fulfillment of vital needs such as protection of the mother and newborn. Finally, the last step of their socialization process is the development of their own institutions, which establishes them within the Chilean public space, thus forming an identity as a community.

La importancia de la autorregulación y la empatía en la formación docente / A importância da autorregulação e empatia na formação de professores / The importance of self-regulation and empathy in teacher training

Este artículo analiza la autorregulación y la empatía percibidas por el alumnado de magisterio de educación infantil en la Universidad de Zaragoza en la práctica de situaciones motrices introyectivas. Se utilizó el diario de prácticas de los estudiantes como instrumento de recogida de datos y se realizó un análisis de contenido de éstos empleando el software NUD*IST 6. Los resultados muestran una reducida presencia de la autorregulación y la empatía en los testimonios de los participantes. Se confirma la necesidad de integrar prácticas motrices introyectivas en la formación docente para desarrollar estas competencias sociopersonales y se proponen algunas orientaciones pedagógicas para este fin.

This article analyses University of Zaragoza students’ perception on selfregulation and empathy in the practice of introjective motor situations. The students’ practice diary was used to collect data, which underwent content analysis using NUD*IST 6 software. The results show reduced self-regulation and empathy in participants’ statements. The need to integrate introjective motor practices into teacher education in order to develop these socio-personal skills was confirmed and some teaching guidelines are proposed for this purpose.

Este artigo analisa a autorregulação e empatia percebidas pelos estudantes da titulação de Maestro especialista en Educación Infantil da Universidad de Zaragoza na prática de situações motrizes introjetivas. Como instrumento de coleta de dados utilizou-se o diário de práticas, realizando-se posteriormente uma análise do conteúdo com o apoio do software NUD*IST 6. Os resultados mostram uma presença reduzida de autorregulação e empatia nos registros analisados. Confirma-se a necessidade de integrar as práticas motrizes introjetivas na formação de professores para desenvolver essas habilidades sociopessoais. Finalmente incluímos diretrizes de ensino para essa finalidade.

Embarazo en menores de quince años: los motivos y la redefinición del curso de vida / Pregnancy under fifteen: The motives and redefinition of life's course

Objetivos. Interpretar los motivos del embarazo en las adolescentes y la resignificación del curso de vida. Material y métodos. Se realizaron 18 relatos de vida de adolescentes menores de 15 años con experiencia de embarazo, en las ciudades de Bogotá, Cali, Cartagena y Medellín, durante 2011 y 2012. Se utilizó un marco analítico fenomenológico para desvelar los motivos y los significados. Resultados. Los "motivos porque" y "motivos para" del curso de vida de las adolescentes son redefinidos por el control moral de familias, parejas, profesionales de educación y salud basados en su sentido común y su habitus profesional. Conclusión. En los auténticos "motivos porque" se encuentra cómo el sentido común asigna la culpa y la responsabilidad del embarazo a las adolescentes. En el contexto educativo existe un dispositivo que excluye y promueve la deserción escolar. En el campo de la salud las violaciones a los derechos humanos se utilizan como un dispositivo de control y punición.

Objectives. To interpret the motives of pregnancy in girls and the re-signification of their life's course. Materials and methods. In the cities of Bogota, Cali, Cartagena and Medellin, 18 life stories of adolescents under 15 years old with experience of pregnancy were made during 2012 and 2013. A phenomenological analytical framework was used to reveal the motives and meanings. Results. The "because motives" and "in order to motives" of adolescents life course, are redefined by the moral control of families, couples, education and health professionals based on common sense and professional habitus. Conclusion. In the real "because motives" it is found that common sense assigns blame and responsibility to teens for their pregnancy. In the educational context there is a device that excludes them and promotes dropouts. In the field of health, human rights abuses are used as a control and punishment mechanism.

Small Heterodimer Partner and Innate Immune Regulation.

The nuclear receptor superfamily consists of the steroid and non-steroid hormone receptors and the orphan nuclear receptors. Small heterodimer partner (SHP) is an orphan family nuclear receptor that plays an essential role in the regulation of glucose and cholesterol metabolism. Recent studies reported a previously unidentified role for SHP in the regulation of innate immunity and inflammation. The innate immune system has a critical function in the initial response against a variety of microbial and danger signals. Activation of the innate immune response results in the induction of inflammatory cytokines and chemokines to promote anti-microbial effects. An excessive or uncontrolled inflammatory response is potentially harmful to the host, and can cause tissue damage or pathological threat. Therefore, the innate immune response should be tightly regulated to enhance host defense while preventing unwanted immune pathologic responses. In this review, we discuss recent studies showing that SHP is involved in the negative regulation of toll-like receptor-induced and NLRP3 (NACHT, LRR and PYD domains-containing protein 3)-mediated inflammatory responses in innate immune cells. Understanding the function of SHP in innate immune cells will allow us to prevent or modulate acute and chronic inflammation processes in cases where dysregulated innate immune activation results in damage to normal tissues.

Small Heterodimer Partner and Innate Immune Regulation

The nuclear receptor superfamily consists of the steroid and non-steroid hormone receptors and the orphan nuclear receptors. Small heterodimer partner (SHP) is an orphan family nuclear receptor that plays an essential role in the regulation of glucose and cholesterol metabolism. Recent studies reported a previously unidentified role for SHP in the regulation of innate immunity and inflammation. The innate immune system has a critical function in the initial response against a variety of microbial and danger signals. Activation of the innate immune response results in the induction of inflammatory cytokines and chemokines to promote anti-microbial effects. An excessive or uncontrolled inflammatory response is potentially harmful to the host, and can cause tissue damage or pathological threat. Therefore, the innate immune response should be tightly regulated to enhance host defense while preventing unwanted immune pathologic responses. In this review, we discuss recent studies showing that SHP is involved in the negative regulation of toll-like receptor-induced and NLRP3 (NACHT, LRR and PYD domains-containing protein 3)-mediated inflammatory responses in innate immune cells. Understanding the function of SHP in innate immune cells will allow us to prevent or modulate acute and chronic inflammation processes in cases where dysregulated innate immune activation results in damage to normal tissues.

El Estado, la espera y la dominación política en los sectores populares: entrevista al sociólogo Javier Auyero / The State, waiting and political domination among the poor: interview with the sociologist Javier Auyero

La extensa obra de Javier Auyero sobre los sectores populares en América Latina inquieta por su complejidad sociológica y política. Alejada de los lugares comunes sobre cómo viven, sufren y se relacionan los habitantes de los márgenes de nuestras ciudades, su programa de veinte años de investigación aborda las consecuencias del neoliberalismo en la marginalidad urbana. Por la publicación de su último libro, Pacientes del Estado (2013), Salud Colectiva lo invita a reflexionar sobre las conexiones, no siempre observadas, entre la espera y la dominación política en oficinas estatales, escuelas y hospitales. Su estrategia etnográfica le permite ingresar sin prejuicios a un universo social atravesado por posicionamientos sociales polarizantes. En los encuentros cotidianos de los pobres con diversas formas de poder estatal, afirma, se reproducen prácticas -no todas ellas igualmente conscientes y planificadas- que imparten educación política y culminan convirtiendo a quienes deberían ser ciudadanos con derechos en pacientes del Estado.

The extensive work of Javier Auyero regarding the poor in Latin America is disturbing in its sociological and political complexity. Instead of falling into the commonplace explorations of how inhabitants at the margins of our cities live, suffer and relate, his twenty years of research have focused on the consequences of neoliberalism in urban marginality. In light of the publication of his last book Patients of the State (2013), Salud Colectiva invited Auyero to reflect on the connections, not always observed, between waiting and political domination in government offices, schools and hospitals. His ethnographic strategy allows him to enter without prejudices into a social universe marked by polarizing political positions. He affirms that in the everyday encounters of poor people with the diverse forms of state power, practices are reproduced - not all of which are equally conscious and planned - that impart a political education and end up turning those who should be citizens into patients of the State.