A medida protetiva de acolhimento institucional de crianças e adolescentes na perspectiva dos estudos nacionais / The protective measure for institutional care of children and adolescents from the perspective of national studies

Resumo O artigo tem como objetivo analisar a produção científica nacional sobre as medidas protetivas de acolhimento institucional para crianças e adolescentes em situação de risco no Brasil. Através da realização de uma revisão integrativa, busca-se refletir sobre as principais tendências, temas, atores institucionais, metodologias e objetivos dos estudos acerca da referida medida e analisar como se apresentam e se articulam as condições e o direito à saúde nessas referências. Seis unidades temáticas foram identificadas no acervo: percepções e papéis de diferentes atores nos processos de acolhimento institucional; processos de autonomia, desligamento e causas de acolhimento institucional; aspectos legislativos, avaliação de serviços e identificação de perfis; convivência familiar e comunitária; educação e formação profissional; e saúde física e mental de crianças e adolescentes acolhidos. No Brasil, especificamente, poucos estudos investigam as concepções dos acolhidos sobre os processos de medida protetiva, assim como o acesso à educação. O vínculo entre pobreza e institucionalização aparece com destaque e fica evidenciada a escassez de atividades visando a reintegração familiar de maneira prioritária. Um número alto de pesquisas aponta para as dificuldades de implementar legislações.

Abstract This article aims to analyze the national scientific production on protective measures aimed at institutional care for at-risk children and adolescents in Brazil. By carrying out an integrative review, we seek to reflect on the main trends, themes, institutional actors, methodologies, and objectives of studies on the aforementioned measure and to analyze how the conditions and the right to health are presented and articulated in these references. Six thematic units were identified in the collection: Perceptions and roles of different actors in institutional reception processes; Processes of autonomy, dismissal, and causes of institutional care; Legislative aspects, evaluation of services, and identification of profiles; Family and community coexistence; Education and professional training; and Physical and mental health of sheltered children and adolescents. In Brazil, specifically, few studies investigate the concepts of the children and adolescents placed in shelters concerning protective measure processes or access to education. The link between poverty and institutionalization appears prominently and the scarcity of activities aimed primarily at family reintegration is evident. A large number of surveys point to the difficulties in implementing legislation.

Continuing work in times of COVID-19: Protection measures in the workplace for health professionals.

BACKGROUND: The arrival of COVID-19 in Brazil and the accelerated process of dissemination/contamination added to the evolution of the clinical picture of the disease, and the saturation of the capacity of health services, creating new challenges for researchers, governments, and professionals involved in the occupational health area. OBJECTIVE: This article aims to systematize and synthesize the proposals adopted by the legislation and by the Brazilian State, with a focus on worker protection and guaranteeing a safe work environment for the performance of their professional activities. METHODS: This is qualitative bibliographical research of the narrative literature review type, developed from October 2020 to June 2021 in legislation databases using the strategy: "COVID-19" AND "coronavirus/coronavirus" AND "worker health" on official Brazilian government websites. RESULTS: The lack of an emergency plan for efficient actions to respond to the epidemic caused and is still causing the daily deaths of workers. CONCLUSION: There is a need to guarantee the effectiveness of national and international policies and norms that have been neglected by the Brazilian government.

Medidas protetivas para o enfrentamento da Covid 19 sob a ótica dos profissionais de saúde de um complexo hospitalar de Curitiba / Protective measures to face Covid 19 from the perspective of health professionals at a hospital complex in Curitiba

Resumo: Objetivo: Analisar as medidas protetivas para a Covid-19 junto aos profissionais de saúde de um complexo hospitalar do município de Curitiba-PR. Materiais e Métodos: Trata-se de uma pesquisa descritiva e analítica, de natureza exploratória e abordagem quantitativa, desenvolvida em um complexo hospitalar universitário da capital paranaense. Nesta pesquisa, para definição da amostra, foi utilizada a técnica de amostragem não intencional e não probabilística, bola de neve e participaram 104 profissionais de saúde (enfermeiros, técnicos de enfermagem, fisioterapeutas e médicos), que atuam em unidades com atendimento direto ao paciente suspeito ou confirmado da Covid-19. A coleta de dados foi desenvolvida entre os meses de maio e agosto de 2021, por meio de entrevista on-line, em que se utilizou de um questionário estruturado, composto por questões fechadas sobre o perfil sócio-ocupacional, histórico ocupacional e medidas de enfrentamento para Covid-19. Os dados foram analisados de forma descritiva e pelos testes de qui quadrado, exato de Fisher, odds ratio com intervalo de confiança de 95%. Resultados: Dos 104 participantes, 57,7% (n=60) eram enfermeiros, 84,6% (n=88) do sexo feminino, 42,3% estavam na faixa etária entre 30 e 39 anos e 38,5% (n=40) tiveram a Covid-19. Com relação à exposição a riscos e agravos: a média de idade entre os profissionais de saúde positivos para Covid-19 foi de 36,2 anos; 62,5% dos participantes referiram estar parcialmente seguros no ambiente de trabalho e contraíram Covid-19; 36,7% dos profissionais de saúde que realizaram procedimentos geradores de aerossol testaram positivo para a doença. Na associação do perfil sócioocupacional com o acidente com material biológico, 5,8% dos profissionais tiveram algum tipo de acidente. Em relação às medidas protetivas para a Covid-19, 66,7% dos profissionais de saúde negativos para o agravo, relataram terem participado de capacitações no ambiente de trabalho (p=0,006 OR: 0,2 [0,06-0,69]). Sobre o fornecimento de equipamentos de proteção Individual, afirmaram a presença deles, 59,2% dos profissionais negativos para covid-19 (p=0,05). Na realização dos cinco momentos de higienização das mãos, 83,3% dos entrevistados que mencionaram realizar a ação na maioria das vezes ao invés de sempre, conforme recomendado, testaram positivo para Covid-19 (p<0,001 OR: 10,89 [2,24-53,03]). Na associação de adesão às medidas protetivas e acidente com material biológico, observou-se que o uso do protetor facial ou óculos de proteção, quando utilizado sempre, foi um fator de proteção para não ocorrer nenhum tipo de acidente (p<0,001). Já, para o uso de equipamentos de proteção individual durante procedimentos geradores de aerossóis, quando comparado com o uso sempre, conforme recomendado, aqueles que mencionaram usar, na maioria das vezes, apresentaram maior risco para acidente (p=0,015 OR:7,67 [1,16-50,63]). Conclusão: Concluiu-se que as medidas protetivas foram indispensáveis e que sua adesão possibilitou redução da exposição dos profissionais de saúde a riscos e agravos à saúde. Ressalta-se que a participação em capacitações, o uso e o fornecimento de equipamentos de proteção individual e a higienização das mãos foram medidas importantes no enfrentamento da pandemia, sendo assim, recomenda-se que essas medidas sejam amplamente utilizadas como barreira contra a exposição dos profissionais de saúde à contaminação pela Covid- 19.

Abstract: Objective: To analyze the protective measures for Covid-19 with health professionals from a hospital complex in the city of Curitiba-PR. Materials and Methods: This is a descriptive and analytical research, with an exploratory nature and a quantitative approach, developed in a university hospital complex in the capital of Paraná. In this research, to define the sample, the unintentional and non-probabilistic sampling technique was used, snowball, and 104 health professionals participated (nurses, nursing technicians, physiotherapists and physicians), who work in units with direct patient care. suspected or confirmed Covid-19. Data collection was carried out between May and August 2021, through an online interview, in which a structured questionnaire was used, consisting of closed questions about the socio-occupational profile, occupational history and coping measures. for Covid-19. Data were analyzed descriptively and by chi-square, Fisher's exact and odds ratio tests with a 95% confidence interval. Results: Of the 104 participants, 57.7% (n=60) were nurses, 84.6% (n=88) were female, 42.3% were aged between 30 and 39 years and 38.5% ( n=40) had Covid-19. Regarding exposure to risks and injuries: the average age among health professionals positive for Covid-19 was 36.2 years; 62.5% of participants reported being partially safe in the work environment and having contracted Covid-19; 36.7% of healthcare professionals who performed aerosol-generating procedures tested positive for the disease. In the association of the socio-occupational profile with the accident with biological material, 5.8% of the professionals had some type of accident. Regarding protective measures for Covid-19, 66.7% of health professionals negative for the disease reported having participated in training in the work environment (p=0.006 OR: 0.2 [0.06-0.69 ]). Regarding the supply of Personal Protective Equipment, 59.2% of professionals were negative for Covid-19 (p=0.05). In performing the five hand hygiene moments, 83.3% of respondents who mentioned performing the action most of the time instead of always, as recommended, tested positive for Covid-19 (p<0.001 OR: 10.89 [2] .24-53.03]). In the association of adherence to protective measures and accidents with biological material, it was observed that the use of face shields or goggles, when used always, was a protective factor for no type of accident to occur (p<0.001). On the other hand, for the use of personal protective equipment during aerosol-generating procedures, when compared to always using it, as recommended, those who mentioned using it, most of the time, had a higher risk of accident (p=0.015 OR:7.67 [1.16-50.63]). Conclusion: It was concluded that the protective measures were indispensable and that their adherence made it possible to reduce the exposure of health professionals to risks and health problems. It is noteworthy that participation in training, the use and supply of personal protective equipment and hand hygiene were important measures in facing the pandemic, therefore, it is recommended that these measures be widely used as a barrier against the exposure of health professionals to contamination by Covid-19.

Assessment of Cytogenetic Damage and Cholinesterases' Activity in Workers Occupationally Exposed to Pesticides in Zamora-Jacona, Michoacan, Mexico.

Pesticides have been considered as potential chemical mutagens; however, little is known about toxic and genotoxic effects during pesticide application in Zamora-Jacona, Michoacan State in Mexico. This study sought to determine DNA damage and cholinesterase activities inhibitions in 54 agricultural workers exposed to complex mixtures of pesticides vs. control group (26 individuals) using Comet assay in peripheral whole blood, micronucleus (MN) test in oral mucosa cells, Cytokinesis-blocked MN assay in lymphocytes (L-CBMNcyt) and measuring AChE and BChE activities in whole blood and plasma samples, respectively. Exposed subjects demonstrated significantly elevated levels of primary (Comet assay: tail intensity, tail length, tail moment, Olive tail moment) and permanent DNA damage (MN assay: in blood/buccal cells; frequencies of nuclear buds, binucleated cells, cells with condensed chromatin, karyorrhexis, pyknosis, and karyolysis). However, inhibition of cholinesterase activities (AChE and BChE) was not observed in the workers. Confounding factors including sex, age, BMI, working exposure period, protection level, smoking habit (cigarettes per day units), alcohol consumption (weekly), medication, were considered in the analysis. These combined techniques demonstrated usefulness in the health hazards risks pesticide exposure assessment and suggested the need for periodic monitoring together with the education and the training of occupational workers for the safe application of potentially harmful pesticides.

Sistema de evacuación seguro de neumoperitoneo y humo quirúrgico en cirugía laparoscópica mediante trampa de agua en tiempos de COVID-19 / Safe evacuation system for pneumoperitoneum and surgical smoke in laparoscopic surgery using a water trap in times of COVID-19

INTRODUCCIÓN: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. MATERIALES Y MÉTODO: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. RESULTADOS: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. CONCLUSIONES: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.

INTRODUCTION: The recent SARS-CoV-2 (COVID-19) pandemics has raised concern on the incidental exposition of health team to air transmissible infectious agents during surgeries. The main goal of this work is to communicate a simple and low-cost filtering system allowing to reduce the risk of contagion related to the virus, associated with pneumoperitoneum removal during surgical laparoscopy. METHODS: A closed circuit of gas removal and filtering was developed and implemented in laparoscopic gynecologic procedures at a tertiary teaching hospital. The circuit included an HEPA (High Efficiency Particulate Air) filter and a vacuum trap containing an inactivating solution based on quaternary ammonium or sodium hypochlorite. RESULTS: Since its introduction, seventeen laparoscopic surgeries have been carried out for different gynecologic pathologies. Two of them in Covid (+) cases. To date, no contagion has been reported among health teammates participating in these surgeries. CONCLUSIONS: It is possible to implement a pneumoperitoneum evacuation system in laparoscopic surgery presumably effective in minimizing the risk of exposure to the SARS-COV-2 virus (Covid-19). Its low cost makes it especially recommended in developing countries.

Lei Maria da Penha, equipe multidisciplinar e medidas protetivas / Maria da Penha Law, multidisciplinary team and protective measures / Ley Maria da Penha, equipo multidisciplinario y medidas protectivas

Investiga-se o papel da Equipe de Atendimento Multidisciplinar na aplicação das medidas protetivas previstas na Lei Maria da Penha, a qual cria mecanismos para coibir a violência doméstica e familiar contra a mulher. A Equipe é composta por assistentes sociais e psicólogos. Com base em levantamento bibliográfico e documental exploram-se as demandas dirigidas à Equipe e as respostas por ela oferecidas, analisando-se os motivos de sua intervenção. Essas respostas apoiam-se nos profissionais envolvidos e relacionam-se com a interpretação da autoridade judicial. A intervenção da Equipe situa-se entre as expectativas e as dúvidas dos atores jurídicos e o acolhimento dos que se dirigem ao sistema judicial. Conclui-se que o aspecto punitivo da legislação não esgota os conflitos expressos nos casos de violência contra a mulher e as medidas protetivas sozinhas não garantem a integridade de sua demandante

The role of the Multidisciplinary assistance team in the execution of protective measures foreseen in Maria da Penha's law, which creates means to prevent domestic and in-house violence against women, is investigated. The team is composed of social workers and psychologists. Based on a bibliographic and documentary review, demands directed to the team are identified, as well as its responses by assessing the team's reasons for intervention. Such responses are based on the professionals and are related to the interpretation of the judicial authority. The intervention of the team is situated between the expectations and the doubts with respect to the justice players and the acceptance of the demands that are directed to it. As a conclusion, the punishment aspect of the legislation does not exhaust the conflicts in the form of violence against a woman and protective measures alone do not guarantee the integrity of women

Se investiga el papel del Equipo de Atención Multidisciplinar en la aplicación de las medidas de protección previstas en la Ley María da Penha, la cual crea mecanismos para cohibir la violencia doméstica y familiar contra la mujer. El equipo está compuesto por asistentes sociales y psicólogos. Con base en levantamiento bibliográfico y documental se exploran las demandas dirigidas al Equipo y las respuestas por él ofrecidas, analizándose los motivos de su intervención. Estas respuestas se apoyan en los profesionales involucrados y se relacionan con la interpretación de la autoridad judicial. La intervención del Equipo se sitúa entre las expectativas y las dudas de los actores jurídicos y la acogida de los que se dirigen al sistema judicial. Se concluye que el aspecto punitivo de la legislación no agota los conflictos presentes en los casos de violencia contra la mujer y las medidas protectivas por sí solas no garantizan la integridad de su demandante

Pericias psicológicas y otros medios probatorios de las decisiones en las comisarías de familia de Bogotá: casos de violencia de pareja contra la mujer / Forensic Psychological Evaluation and Other Evidences to the Decision Making Process in Administrative Family Courts in Bogotá: Partner Violence Against Women

En este artículo se presenta el estudio que establece la asociación de las pericias psicológicas y otros medios probatorios con las decisiones de los operadores de justicia en las Comisarías de Familia de Bogotá; para lo cual, se realizó una investigación con diseño analítico de corte transversal descriptivo con 47 mujeres víctimas de violencia de pareja que solicitaron medida de protección en el Centro de Atención Integral contra la Violencia Intrafamiliar (CAVIF). Se analizaron los fallos de las medidas de protección definitivas impuestas en 16 comisarías de familia de 13 localidades de Bogotá. Los resultados mostraron que no existe asociación entre la utilización de las pericias psicológicas, dictamen de lesiones no fatales del Instituto Nacional de Medicina Legal y Ciencias Forenses (INMLCF), informes sociales, denuncias de Fiscalía y testimonios de terceros, con las decisiones tomadas por los comisarios de familia. Solo se encontró asociación entre la aceptación de cargos, con las decisiones de aprobación de acuerdo conciliatorio y conminación a no agresión del accionado.

This study aimed to establish the association of the forensic psychological evaluation and other evidences to the decision making process by judicial operators in administrative family courts in Bogotá, through a research with a transversal descriptive cut analytical design on 47 women, victims of partner violence, who sought protective measures at the Integral Care Center against Domestic Violence (CAVIF). Analyzing the final protective measures imposed in 16 administrative family courts on Bogotá, the results showed no association between the use of forensic psychological evaluations, expert's concept of nonfatal injuries from the National Institute of Legal Medicine and Forensic Sciences (INMLCF), social forensic report, legal complaint, witness testimony and the decisions made by the family commissioner. The only association found was between acceptance of charges and approval decisions for settlement's agreements, as well as with the party's injunction to non-aggression.

A convivência familiar e comunitária é direito da criança e do adolescente e uma realidade a ser repensada pela escola / Family and community coexistence is a right of children and adolescents and a reality that should be rethought by school

O tema sobre a convivência familiar e comunitária como um direito de crianças e adolescentes, à primeira vista, se mostra bastante abstrato e ocupando ao mesmo tempo um lugar-comum. A sociedade aceita facilmente o fato de que toda criança tem direito a nascer e crescer em um lar saudável, protegido e seguro. Entretanto, muitas são as crianças que enfrentam situações de extrema vulnerabilidade pessoal e social, tendo que se afastar de suas famílias de origem para viver em situação de abrigamento, como medida protetiva. Este artigo tem como objetivo principal, a partir do que está preconizado no Plano Nacional de Promoção, Proteção e Defesa do Direito de Crianças e Adolescentes à Convivência Familiar e Comunitária e em leis anteriores (Constituição Federal Brasileira de 1988 e na Lei n. 8069/90 - Estatuto da Criança e do Adolescente), apresentar uma análise sobre os desafios e transformações que serão imprescindíveis para que esse direito seja efetivado, abordando os principais aspectos que envolvem as responsabilidades das políticas sociais brasileiras, com ênfase na educação pública.

At first sight, family and community coexistence as a legal right for children and adolescents seems quite abstract, although it occupies a common place. Society easily accepts that every child has the right to be born and raised within a healthy, protective and safe home. However, social and personal vulnerability force many children to leave their families and live in foster homes or shelters, as a protective measure. The main goal of this paper is to analyze the challenges and transformations needed in order to enforce children and adolescents' rights, in compliance with the National Plan for Social Devel opment, Protection and Defense of the Rights of Children and Adolescents to Family and Community Coexistence and other previous laws (1998 Brazilian Federal constitution and Law n. 8069/90 Children and Teenager's Statute), by approaching the main aspects involving the responsibilities of Brazilian social policies, with an emphasis on public education.

Acolhimento familiar: uma alternativa de proteção para crianças e adolescentes / Family foster care: a protective alternative for children and adolescents

O acolhimento de crianças e adolescentes que vivenciam violação de direitos tem sido discutido no âmbito do desenvolvimento de políticas públicas e no meio acadêmico. Tais discussões visam elaborar diretrizes que garantam o direito à convivência familiar e comunitária e evidenciam um campo em reordenamento. Este artigo contextualiza o acolhimento familiar no cenário nacional, considerando-o como uma medida de proteção possível para crianças e adolescentes em situação de vulnerabilidade. Discute-se também o reflexo de algumas perspectivas teóricas que abordam as relações de vínculo afetivo em situações de acolhimento. Argumenta-se que ao fomentar uma nova cultura de acolhimento são necessárias mudanças nas concepções de infância e juventude, nas significações de vinculação afetiva e nas políticas de assistência à infância e juventude.

Foster care of children and adolescents who have had their rights violated is being discussed both in the scientific literature and in agencies involved in the development of public policies. Such discussions, which aim to define some guidelines to guarantee the right to family and community inclusion, expose a field under change. This paper focuses on foster care in the Brazilian context and presents it as one of the possible alternatives for children and adolescents in risk situations. The (mis)leading influences of some theoretical perspectives that deal with affective bonds in foster care are also discussed. It is argued that a new foster culture requires changes in the conceptions of infancy and youth, in the meanings of affectionate bonds, and in welfare policies for children and adolescents.