[Evaluation of pharmaceutical practice in hospitals: An exploratory study comparing processes in France and Quebec]. / Évaluation de la pratique pharmaceutique en établissement de santé : une étude exploratoire comparant les processus en France et au Québec.

CONTEXT: To ensure compliance with the legal and normative framework, the professional orders, which supervise the practice of pharmacy have established a professional inspection process. In addition to this process, other external organizations also require an accreditation, authorization, certification or validation process for professional practices. OBJECTIVE: The main objective is to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec. RESULTS: In order to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec, our approach allowed us to identify more organizations in France (i.e., High Authority of Health, Regional Health Agencies, the National Order of Pharmacists, the Nuclear Safety Agency, the Biomedicine Agency and the National Agency for the Safety of Medicines and Health Products) than in Quebec (i.e., Accreditation Canada, Ordre des pharmaciens du Québec and Health Canada). The study highlights the legal framework and applicable standards, the surveyors, the evaluation methods and the particularities for the evaluation of the hospital, the pharmacy department and the members of the department. CONCLUSIONS: This study highlights the evaluation processes of pharmaceutical practice in hospitals. In France, as in Quebec, we recognize the importance of the drug circuit in the hospital, the development and operation of a pharmacy department and the practice of pharmacy. While there are more similarities for the assessment of the drug circuit in hospitals and pharmacy department, important differences are observed for the assessment of individuals. We believe that the publication of a comparative analysis can contribute to discussions and exchanges to benefit from the best practices of each country.

O Real à prova, um momento decisivo de orientação para o futuro / Lo Real a prueba, un momento decisivo de orientación para el futuro / Real to the test, a decisive moment of guidance for the future / L'épreuve du réel, un moment d'orientation de l'avenir

A escolha de uma carreira durante a adolescência é uma etapa decisiva e muitas vezes opressora para os alunos. Geralmente entendida como a necessidade de um compromisso entre as demandas da realidade e os desejos individuais, a noção de Real oferece outras vias de análise que nos permitem compreender melhor a ansiedade suscitada. Ao abordar a questão do prazer e do desejo, a submissão a uma escolha de orientação pode de fato induzir uma intrusão psíquica. A retomada de certos momentos essenciais da juventude do escritor francês, André Gide, identificados por Lacan, permitirá precisar suas implicações e proporcionará caminhos de reflexão para considerar as modalidades de saída da adolescência por ocasião da escolha da orientação. Veremos então a importância de proferir uma palavra autorizadora para que o sujeito seja o autor de sua vida

Elegir una carrera profesional durante la adolescencia es un paso decisivo que a menudo resulta abrumador para los estudiantes. Generalmente entendida como la necesidad de un compromiso entre las exigencias de la realidad y los deseos individuales, la noción de realbrinda otras vías de análisis que nos permiten comprender mejor la angustia suscitada. Al abordar la cuestión del disfrute y el deseo, la sumisión a una elección de orientación puede inducir una intrusión psíquica. La reanudación de ciertos momentos esenciales de la juventud del escritor francés André Gide identificados por Lacan permitirá concretar sus implicaciones y proporcionará vías de reflexión para considerar las modalidades de una salida de la adolescencia con motivo de la elección de la orientación. Veremos entonces la importancia de pronunciar una palabra autorizante para que el sujeto pueda ser el autor de su vida

Elegir una carrera profesional durante la adolescencia es un paso decisivo que a menudo resulta abrumador para los estudiantes. Generalmente entendida como la necesidad de un compromiso entre las exigencias de la realidad y los deseos individuales, la noción de real-brinda otras vías de análisis que nos permiten comprender mejor la angustia suscitada. Al abordar la cuestión del disfrute y el deseo, la sumisión a una elección de orientación puede inducir una intrusión psíquica. La reanudación de ciertos momentos esenciales de la juventud del escritor francés André Gide identificados por Lacan permitirá concretar sus implicaciones y proporcionará vías de reflexión para considerar las modalidades de una salida de la adolescencia con motivo de la elección de la orientación. Veremos entonces la importancia de pronunciar una palabra autorizante para que el sujeto pueda ser el autor de su vida

Choosing a career path during adolescence is a decisive step that is often overwhelming for students. Generally understood as the need for a compromise between the demands of realityand individual desires, the notion of realprovides other avenues of analysis that allow us to better understand the anxiety aroused. By engaging the question of jouissanceand desire, submission to a choice of orientation can indeed induce a psychic intrusion. The resumption of certain essential moments of the youth of the French writer André Gide identified by Lacan will make it possible to specify its implications and will provide avenues for reflection to consider the modalities of an exit from adolescence on the occasion of the choice of orientation. We will then see the importance of uttering an authorizing word so that the subjectcan be the author of his life

Choisir une orientation professionnelle à l'adolescence constitue une étape décisive souvent oppressante pour les élèves. Généralement appréhendée comme la nécessité d'un compromis entre les exigences de la réalité et les désirs individuels, la notion de réel fournit d'autres pistes d'analyse qui permettent de mieux saisir l'angoisse suscitée. En engageant la questionde la jouissance et du désir, la soumission à un choix d'orientation peut en effet induire une effraction psychique. La reprise de certains moments essentiels de la jeunesse de l'écrivain français André Gide repérés par Lacan permettra de préciser ses implications et fournira des pistes de réflexion pour envisager les modalités d'une issue de l'adolescence à l'occasion du choix d'orientation. Nous verrons alors l'importance que revêt l'énonciation d'une parole autorisatrice pour que le sujet puisse être auteur de sa vie

[Analysis of off-label prescriptions of medicines in hospital in adult patients and feasibility study of their detection using CIM-10 coding]. / Analyse des prescriptions hospitalières hors AMM des médicaments chez l'adulte et étude de la faisabilité de leur détection par le codage CIM-10 du PMSI.

Analysis of off-label prescriptions of medicines in hospital in adult patients and study of feasibility of their detection by use of international disease classification, 10th version (IDC-10 codes). CONTEXT: In order to improve the appropriate use of medicines, a method of detection of off label prescriptions, especially in hospitalised patients, should be available. STUDY OBJECTIVES: Evaluate the performance of the detection of off-label prescriptions in hospitalised patients by use of IDC-10 codes. METHODS: Data prescriptions (excluding those directly taken in charge by the national health care system), clinical history and biological results were extracted from Assistance publique des Hôpitaux de Paris (AP-HP) data-warehouse for 108 in-hospital adults patients' journeys. An adjudication committee established the classification reference for the appropriate or off label drug prescriptions status after analysis of medical information for each patient. IDC-10 codification that is performed after every hospitalisation was crossed with those IDC-10 codes that were to be expected corresponding to the marketing authorisation labelling (section 4.1 of specifications of product characteristics [SPC]). Results of IDC-10 coding were compared to the reference for off label use identification. RESULTS: Out of the 1131 analysed prescriptions, 44 (3.9%) were classified as off label by the adjudication committee. Sensitivity of detection by IDC-10 coding was 87 (95% CI [0.73-0.96]) to 92% (95% CI [0.79-0.98]) and specificity 25 (95% CI [0.22-0.27]) to 41% (95% CI [0.38-0.44]) according to the number of characters of ICD-10 that could be used. CONCLUSIONS: Incidence of in-hospital off label use of drugs (restricted to within drug related groups prescriptions) appeared relatively low (3.9%). Its semi-automatic detection by IDC-10 coding appears feasible with a good sensitivity but a low specificity. Such method could be further assessed as a first step detection focusing on one pharmacological class or on one pathologic condition.

O supervisor suposto saber: perspectivas lacanianas sobre a análise de controle / The supervisor supposed to know: Lacanian perspectives on control analysis / El supervisor supuesto saber: perspectivas lacanianas sobre el análisis de control / Le superviseur supposé savoir: perspectives lacaniennes concernant l'analyse de contrôle

De forma a preservar o ímpeto evolutivo e o alcance da psicanálise, a tarefa da análise de controle é prevenir o estabelecimento da inércia que busca o menor denominador comum e a degeneração de ideias e práticas em evolução na direção de banalizações e preconceitos. A uma instituição psicanalítica é necessário manter padrões mínimos e simultaneamente preservar-se como ambiente vibrante e dinâmico para o contínuo desenvolvimento e regeneração da psicanálise enquanto estrutura viva e simbólica. Através de uma análise de controle, cada analista adquire um estilo analítico único, que não se refere a preferências e idiossincrasias egoicas, mas a uma singular e nova articulação subjetiva dos elementos preexistentes na estrutura tradicional. Sem a realização de uma análise pessoal, a análise da contratransferência e da identificação projetiva em supervisão pode operar como resistência à análise pessoal, essa última o mais importante fator para a autoautorização do analista dentro da organização psicanalítica. O analista não é autorizado pela supervisão ou pelo supervisor, mas pela experiência analítica pessoal com o inconsciente, o sintoma e seus efeitos pós-analíticos sob a forma do que Lacan nomeia de sinthoma. Lacan diz que, ao término da análise, o analisando ou futuro analista não se identifica com o analista, mas sim com seu sinthoma.

The task of control analysis is to preserve the evolutionary impetus and edge of psychoanalysis and prevent the inertia towards the lowest common denominator, and the degeneration of evolved ideas and practices into common assumptions and prejudices. A psychoanalytic organization needs to maintain standards while also preserving the organization as a vibrant and dynamic site for the continuing development and re-invention of psychoanalysis as a living symbolic structure. Through a control analysis every analyst acquires a unique analytical style that does not refer to ego preferences and idiosyncrasies, but to a singular and new subjective articulation of the pre-existing elements of a traditional structure. Without a personal analysis, the analysis of the countertransference and of projective identification in supervision can function as a resistance to the personal analysis which is the most important factor for the self-authorization of the analyst within a psychoanalytic organization. The analyst is not authorized by supervision or the supervisor, but by the personal analytical experience with the unconscious, the symptom, and its post-analytical effects in the form of what Lacan calls the sinthome. Lacan said that at the end of analysis, the analysand or the future analyst does not identify with the analyst, but rather with his/her sinthome.

Con el fin de preservar el ímpetu evolutivo y el alcance del psicoanálisis, la tarea del análisis de control es evitar el establecimiento de inercias que buscan el mínimo común denominador y la degeneración de ideas y prácticas en la evolución en la dirección de trivializaciones y prejuicios. Para una institución psicoanalítica es necesario mantener estándares mínimos y simultáneamente preservarse como un entorno vibrante y dinámico para el desarrollo continuo y la regeneración del psicoanálisis como una estructura viva y simbólica. A través de un análisis de control, cada analista adquiere un estilo analítico único que no se refiere a preferencias del ego e idiosincrasias, sino a una singular y nueva articulación subjetiva de los elementos preexistentes en la estructura tradicional. Sin realizar un análisis personal, el análisis de la contratransferencia y la identificación proyectiva en la supervisión puede operar como resistencia al análisis personal, este último el factor más importante para la auto autorización del analista dentro de la organización psicoanalítica. El analista no está autorizado por la supervisión o el supervisor, sino por la experiencia analítica personal con el inconsciente, el síntoma y sus efectos posanalíticos en forma de lo que Lacan llama sinthoma. Lacan dijo que al final del análisis, el analista o analista futuro no se identifica con el analista, sino con su sinthoma.

De façon à préserver l'élan évolutif et l'étendue de la psychanalyse, la tâche de l'analyse de contrôle est celle de prévenir l'établissement de l'inertie qui cherche le plus petit dénominateur commun et la dégénération d'idées et de pratiques en évolution dans la direction des banalisations et des préjugés. Il faut qu'une institution psychanalytique maintienne des étalons minimaux et simultanément se préserver en tant qu'une ambiance vibrante et dynamique pour le développement continu et régénération de la psychanalyse considérée comme une structure vive et symbolique. Par l'intermédiaire d'une analyse de contrôle, chaque analyste acquiert un style analytique unique qui ne se réfère pas à des préférences et des idiosyncrasies égoïques, mais à une nouvelle articulation singulière et subjective des éléments préexistant dans la structure traditionnelle. Sans mener une analyse personnelle, l'analyse du contre-transfert et de l'identification projective en supervision peuvent opérer en tant que résistance à l'analyse personnelle, cette dernière le plus important élément pour l'auto autorisation de l'analyste chez l'organisation psychanalytique. L'analyste n'est pas autorisé par la supervision ou par le superviseur, mais par l'expérience analytique personnelle du surmoi, du symptôme et de ses effets postanalytiques, sous la forme de ce qui Lacan nomme sinthome. Lacan dit que, à la fin de l'analyse, l'analysant ou le futur analyste ne s'identifie pas à l'analyste, mais à son sinthome.

[Hybrid medicines in France. Hybrid medicines: Genesis and legal framework in Europe and in France]. / Les médicaments hybrides en France. Genèse des médicaments hybrides et cadre règlementaire en Europe et en France.

Hybrid medicines are defined as medicines that do not fill generic medicines' definition, forming a medicines group that stands half-way between reference medicinal products and generic medicines. The term "hybrid" was introduced in France in 2018, but the concept has existed for some fifteen years in Community legislation. The aim of this work is to expose hybrid medicines' legal framework, in Europe and in France. Hybrid medicines' European legal framework specifies in a guide of the European Medicines Agency, marketing authorization procedures that can be used for hybrid medicines, and what is required for marketing authorization applications. In France, a register of hybrid medicines' groups has been created, and registration procedures were specified in a decree at the end of 2019. Legal texts also underlined that substitution within hybrid medicines' group would be possible for some specific medical cases. Decrees specifying hybrid medicines' groups list and specific medical cases allowing substitution, are not appeared yet at the end of February 2021. Moreover, some elements have never been raised, particularly medical and economic assessment modalities.

[Access to professional nursing practice in Quebec: The essential steps]. / Accès à l'exercice professionnel infirmier au Québec : les étapes incontournables.

Some Quebec health care institutions have nursing teams composed largely of French professionals. A French nurse who has practised in the hospital sector in Montreal offers feedback on obtaining authorizations to practise nursing, on reception, integration, training and probation. These are all essential steps on the road to employment in this French-speaking province of Canada.

Post-marketing drug withdrawals: Pharmacovigilance success, regulatory problems.

Modern pharmacovigilance began in the 1960s, since when the subject has grown markedly, interest having particularly increased since 2010. One index of its success is the increasing speed with which serious adverse drug reactions are discovered after marketing of a medicinal product. However, the speed with which products have subsequently been withdrawn as a result of the discovery of serious adverse reactions has not consistently changed. This highlights problems that regulators and manufacturers face when serious reactions are discovered, with difficulties in deciding which of several consequent actions to take: to add specific warnings (cautions) or contraindications to the product label; to issue a Direct Healthcare Professional Communication; to allow informed patients to decide whether they will take the drug; or, in the most serious cases, to withdraw the product or revoke the licence. Conflicts of interest may inhibit decision-making. Recommendations that arise from these observations are that: health professionals and patients should be more vigorously encouraged to report suspected adverse drug reactions; regulatory authorities and drug manufacturers should take quicker confirmatory action when serious suspected adverse drug reactions are reported, even anecdotally, with formal studies to test for causality conducted sooner rather than later, applying lower than usual thresholds for suspicion; temporary suspensions or restrictions could be considered during such assessments; universal guidelines are needed for determining when a drug should be withdrawn if serious adverse drug reactions are suspected; there should be more rigorous monitoring and verification of deaths and reporting of reasons for drop-outs during clinical trials, with more transparency in reporting adverse events and ready access to premarketing clinical study reports; post-marketing drug monitoring systems and medicines regulation in low-to-middle income economies, especially in Africa, where withdrawals are fewer than elsewhere, should be strengthened.

Herbicide targets and detoxification proteins in sugarcane: from gene assembly to structure modelling.

In a genome context, sugarcane is a classic orphan crop, in that no genome and only very few genes have been assembled. We have devised a novel exome assembly methodology that has allowed us to assemble and characterize 49 genes that serve as herbicide targets, safener interacting proteins, and members of herbicide detoxification pathways within the sugarcane genome. We have structurally modelled the products of each of these genes, as well as determining allelic, genomic, and RNA-Seq based polymorphisms for each gene. This study provides the largest collection of sugarcane structures modelled to date. We demonstrate that sugarcane genes are highly polymorphic, revealing that each genotype is evolving both uniquely and independently. In addition, we present an exome assembly system for orphan crops that can be executed on commodity infrastructure, making exome assembly practical for any group. In terms of knowledge about herbicide modes of action and detoxification, we have advanced sugarcane from a crop where no information about any herbicide-associated gene was available to the situation where sugarcane is now a species with the single largest collection of known and annotated herbicide-associated genes.

Triple therapy in treatment-experienced patients with HCV-cirrhosis in a multicentre cohort of the French Early Access Programme (ANRS CO20-CUPIC) - NCT01514890.

BACKGROUND & AIMS: In phase III trials, the safety profile of triple therapy (pegylated interferon/ribavirin with boceprevir or telaprevir) seems to be similar in HCV treatment-experienced cirrhotic and non-cirrhotic patients, but few cirrhotics were included. We report the week 16 safety and efficacy analysis in a cohort of compensated cirrhotics treated in the French Early Access Programme. METHODS: 674 genotype 1 patients, prospectively included, received 48 weeks of triple therapy. The analysis is restricted to 497 patients reaching week 16. RESULTS: A high incidence of serious adverse events (40.0%), and of death and severe complications (severe infection or hepatic decompensation) (6.4%), and a difficult management of anaemia (erythropoietin and transfusion use in 50.7% and 12.1%) were observed. Independent predictors of anaemia < 8 g/dl or blood transfusion were: female gender (OR 2.19, 95% CI 1.11-4.33, p=0.024), no lead-in phase (OR 2.25, 95% CI 1.15-4.39, p=0.018), age ≥ 65 years (OR 3.04, 95% CI 1.54-6.02, p=0.0014), haemoglobin level (≤ 12 g/dl for females, ≤ 13 g/dl for males) (OR 5.30, 95% CI 2.49-11.5, p=0.0001). Death or severe complications were related to platelets count ≤ 100,000/mm(3) (OR 3.11, 95% CI 1.30-7.41, p=0.0105) and albumin <35 g/dl (OR 6.33, 95% CI 2.66-15.07, p=0.0001), with a risk of 44.1% in patients with both. However, the on-treatment virological response was high. CONCLUSIONS: The safety profile was poor and patients with platelet count ≤ 100,000/mm(3) and serum albumin <35 g/L should not be treated with the triple therapy.

A desautorização do processo perceptivo na negação não psicótica da gravidez / Disallowing the perceptive process in the non-psychotic denial of pregnancy / El no-autorización del proceso perceptivo en la negación psicótica del embarazo / La desautorizacion du processus perceptif dans non psychotiques déni de grossesse

A literatura científica mundial adota atualmente a denominação de negação não psicótica da gravidez para se referir à situação na qual uma mulher não sabe que está grávida até o momento do parto, ou pelo menos durante boa parte do período gestacional. Pode ser definida, também, como a falta de consciência subjetiva por parte da mulher em relação a estar grávida. Esse fenômeno é explorado neste artigo mediante a abordagem de conflitos e mecanismos psíquicos que sustentam sua dinâmica psíquica. Para tal, discorre-se sobre o mecanismo Verleugnung, a partir de proposições do psicanalista Luis Cláudio Figueiredo, no sentido de traduzi-lo como "desautorização". Entende-se que na situação da negação não psicótica da gravidez, explorada sob o viés da desautorização, se encontram ampliadas as condições de compreensão a respeito do estabelecimento de uma condição psíquica singular a qual resulta na situação em que uma mulher não toma conhecimento de sua condição de estar gerando outro ser. Também são apresentadas contribuições de autores psicanalíticos contemporâneos que fornecem pertinentes ferramentas de compreensão no que diz respeito à situação da negação não psicótica da gravidez. Tal fenômeno, ao desautorizar a percepção e gerar um impedimento de estabelecer conexões psíquicas e atribuir sentido a esta experiência, resulta no predomínio de intensidades traumáticas no psiquismo...

The scientific literature adopts, currently, the name non-psychotic denial of pregnancy to denominate a situation in which a woman does not know that she is pregnant until labor, or at least, for most of the gestational period. The situation can also be defined as a lack of subjective awareness of the woman concerning her pregnancy. This phenomenon is explored in this article addressing the conflicts and psychic mechanisms which support its psychic dynamic. In order to explore this phenomenon, we discuss the mechanism of Verleugnung from the ideas of the psychoanalyst Luis Cláudio Figueiredo who translates Verleugnung as "disallow". The comprehension of the non-psychotic denial of the pregnancy condition, through the concept of disallow, can broaden our understanding regarding the establishment of this singular psychic condition which results in the situation when a woman is not aware of her own pregnancy. We also present some contributions of contemporary psychoanalytical authors who give us essential tools for understanding the situation of non-psychotic denial of pregnancy. This phenomenon, that disallows perception and generates an obstruction for the establishment of psychological connections which gives meaning to the experience, results in a predominance of traumatic intensities in the psyche...

La literatura científica mundial adopta actualmente la denominación de negación no psicótica del embarazo para referir a la situación en la cual una mujer no sabe que está embarazada hasta el momento del parto, o por lo menos durante buena parte del período gestacional. Puede ser definida también, como la falta de conciencia subjetiva por parte de la mujer en relación a estar embarazada. Ese fenómeno es explorado en este artículo mediante el abordaje de conflictivas y de mecanismos psíquicos que sustentan su dinámica psíquica. Para tal, se discurre sobre el mecanismo Verleugnung, a partir de proposiciones del psicoanalista Luis Cláudio Figueiredo, en el sentido de traducirlo como "desautorización". Se entiende que en la situación de la negación no psicótica del embarazo explorada a partir de la óptica de la desautorización se encuentran ampliadas las condiciones de comprensión al respecto del establecimiento de una condición psíquica singular la cual resulta en la situación en que una mujer no toma conocimiento de su condición de estar generando otro ser. También son abordados aportes de autores psicoanalíticos contemporáneos que proporcionan pertinentes herramientas de comprensión al respecto de la situación de la negación no psicótica del embarazo. Tal fenómeno, al desautorizar la percepción y generar un impedimento de establecer conexiones psíquicas y atribuciones de sentido a esta experiencia, resulta en el predominio de intensidades traumáticas en el psiquismo...

La littérature scientifique mondiale adopte actuellement la dénomination de déni non psychotique de grossesse pour se rapporter à la situation où une femme ne sait pas qu'elle est enceinte jusqu'au moment de l'accouchement, ou au moins pendant une grande partie de la gestation. On peut la définir également en tant que manque de conscience subjective de la femme au fait d'être enceinte. Ce phénomène sera développé dans le présent article par le biais de conflits et de mécanismes psychiques que soutiennent la dynamique psychique. Pour autant, nous aborderons le mécanisme de la Verleugnung, à partir des propositions du psychanalyste Luis Cláudio Figeuiredo, dans le sens d'en traduire comme ®des-autorisation¼. On comprend qu'en abordant la situation du déni non psychotique de grossesse par la des-autorisation on amplifie les conditions de compréhension de l'établissement d'une condition psychique singulière, dans laquelle se trouve une femme qui ne prend pas conscience de sa grossesse. On présente également ici les contributions des auteurs psychanalytiques contemporains qui nous offrent des outils importants à la compréhension du déni non psychotique de grossesse. Tel phénomène, en des-autorisant la perception et en établissant un empêchement de liaisons psychiques à l'attribution de sens à cette expérience, aboutit à une prédominance des intensités traumatiques dans le psychisme...

A desautorização do processo perceptivo na negação não psicótica da gravidez / Disallowing the perceptive process in the non-psychotic denial of pregnancy / El no-autorización del proceso perceptivo en la negación psicótica del embarazo / La desautorizacion du processus perceptif dans non psychotiques déni de grossesse

A literatura científica mundial adota atualmente a denominação de negação não psicótica da gravidez para se referir à situação na qual uma mulher não sabe que está grávida até o momento do parto, ou pelo menos durante boa parte do período gestacional. Pode ser definida, também, como a falta de consciência subjetiva por parte da mulher em relação a estar grávida. Esse fenômeno é explorado neste artigo mediante a abordagem de conflitos e mecanismos psíquicos que sustentam sua dinâmica psíquica. Para tal, discorre-se sobre o mecanismo Verleugnung, a partir de proposições do psicanalista Luis Cláudio Figueiredo, no sentido de traduzi-lo como "desautorização". Entende-se que na situação da negação não psicótica da gravidez, explorada sob o viés da desautorização, se encontram ampliadas as condições de compreensão a respeito do estabelecimento de uma condição psíquica singular a qual resulta na situação em que uma mulher não toma conhecimento de sua condição de estar gerando outro ser. Também são apresentadas contribuições de autores psicanalíticos contemporâneos que fornecem pertinentes ferramentas de compreensão no que diz respeito à situação da negação não psicótica da gravidez. Tal fenômeno, ao desautorizar a percepção e gerar um impedimento de estabelecer conexões psíquicas e atribuir sentido a esta experiência, resulta no predomínio de intensidades traumáticas no psiquismo.(AU)

The scientific literature adopts, currently, the name non-psychotic denial of pregnancy to denominate a situation in which a woman does not know that she is pregnant until labor, or at least, for most of the gestational period. The situation can also be defined as a lack of subjective awareness of the woman concerning her pregnancy. This phenomenon is explored in this article addressing the conflicts and psychic mechanisms which support its psychic dynamic. In order to explore this phenomenon, we discuss the mechanism of Verleugnung from the ideas of the psychoanalyst Luis Cláudio Figueiredo who translates Verleugnung as "disallow". The comprehension of the non-psychotic denial of the pregnancy condition, through the concept of disallow, can broaden our understanding regarding the establishment of this singular psychic condition which results in the situation when a woman is not aware of her own pregnancy. We also present some contributions of contemporary psychoanalytical authors who give us essential tools for understanding the situation of non-psychotic denial of pregnancy. This phenomenon, that disallows perception and generates an obstruction for the establishment of psychological connections which gives meaning to the experience, results in a predominance of traumatic intensities in the psyche.(AU)

La literatura científica mundial adopta actualmente la denominación de negación no psicótica del embarazo para referir a la situación en la cual una mujer no sabe que está embarazada hasta el momento del parto, o por lo menos durante buena parte del período gestacional. Puede ser definida también, como la falta de conciencia subjetiva por parte de la mujer en relación a estar embarazada. Ese fenómeno es explorado en este artículo mediante el abordaje de conflictivas y de mecanismos psíquicos que sustentan su dinámica psíquica. Para tal, se discurre sobre el mecanismo Verleugnung, a partir de proposiciones del psicoanalista Luis Cláudio Figueiredo, en el sentido de traducirlo como "desautorización". Se entiende que en la situación de la negación no psicótica del embarazo explorada a partir de la óptica de la desautorización se encuentran ampliadas las condiciones de comprensión al respecto del establecimiento de una condición psíquica singular la cual resulta en la situación en que una mujer no toma conocimiento de su condición de estar generando otro ser. También son abordados aportes de autores psicoanalíticos contemporáneos que proporcionan pertinentes herramientas de comprensión al respecto de la situación de la negación no psicótica del embarazo. Tal fenómeno, al desautorizar la percepción y generar un impedimento de establecer conexiones psíquicas y atribuciones de sentido a esta experiencia, resulta en el predominio de intensidades traumáticas en el psiquismo.(AU)

La littérature scientifique mondiale adopte actuellement la dénomination de déni non psychotique de grossesse pour se rapporter à la situation où une femme ne sait pas qu'elle est enceinte jusqu'au moment de l'accouchement, ou au moins pendant une grande partie de la gestation. On peut la définir également en tant que manque de conscience subjective de la femme au fait d'être enceinte. Ce phénomène sera développé dans le présent article par le biais de conflits et de mécanismes psychiques que soutiennent la dynamique psychique. Pour autant, nous aborderons le mécanisme de la Verleugnung, à partir des propositions du psychanalyste Luis Cláudio Figeuiredo, dans le sens d'en traduire comme «des-autorisation». On comprend qu'en abordant la situation du déni non psychotique de grossesse par la des-autorisation on amplifie les conditions de compréhension de l'établissement d'une condition psychique singulière, dans laquelle se trouve une femme qui ne prend pas conscience de sa grossesse. On présente également ici les contributions des auteurs psychanalytiques contemporains qui nous offrent des outils importants à la compréhension du déni non psychotique de grossesse. Tel phénomène, en des-autorisant la perception et en établissant un empêchement de liaisons psychiques à l'attribution de sens à cette expérience, aboutit à une prédominance des intensités traumatiques dans le psychisme.(AU)

Sociedade civil, instituições participativas e representação: da autorização à legitimidade da ação / Civil society, participative institutions, and representation: from authorization to action legitimacy

In democratic Brazil, political participation has been characterized by the enlargement of civil society's presence in public policies. Such presence generated a series of institutions with the participation of civil society and state actors in the areas of social welfare, health and urban policies. Within these institutions, it began to happen what we can call an institutionalized representation of civil society. This representation is characterized by the inexistence of an explicit requirement of authorization, and the absence of a structure of territorial monopoly in the representation carried out by the actors of civil society. Representation by affinity is proposed as a manner of associating parliamentary representation and representation of civil society.

Dans le Brésil démocratique, la participation politique est marquée par une plus grande présence de la société civile dans le domaine des politiques publiques. Cette présence a engendré une série d'institutions où participent la société civile et des acteurs des États agissant sur le terrain de l'assistance sociale, de la santé et des politiques urbaines. Ces institutions ont fait apparaître ce qu'on peut appeler une représentation institutionnalisée de la société civile, dont les caractères sont tout d'abord l'absence explicite d'autorisation ainsi que l'absence de structure de monopole territorial dans la représentation effectuée par des acteurs de la société civile. Dans cet article, on cherche à discuter une façon de penser la légitimité de cette représentation en proposant la représentation par affinités comme susceptible d'associer représentation parlementaire et représentation de la société civile.

[Not Available]. / Spécificités pédiatriques de l'utilisation des antifongiques.

Specificity of antifungals use in paediatric patients is linked to mycoses epidemiology in this population. Pharmacokinetics vary with patient age. Although studies are in progress, pharmacokinetic data in children are limited in number for most antifungals. Among antifungal agents, those approved in France for use in children are rare. Adverse event frequency can differ in children, as compared to frequency in adults, and drug interaction should be a major worry. Relative interest and cost of available forms in the paediatric population in not always taken into account. For each different situation, an optimal strategy of antifungals use in children should be determined.