Differences between Patients with Sporadic and Familial Pheochromocytoma-Is It Possible to Avoid Genetic Testing in Certain Patients?

BACKGROUND: Pheochromocytoma (PHEO) is a rare neuroendocrine tumour with a strong genetic link, which therefore may modify its clinical behaviour and prognosis. The aim of the study is to evaluate the epidemiological and clinical differences between patients with sporadic and familial PHEO, as well as the specific differences in the index cases. METHODS: A retrospective analysis of 136 patients in a tertiary hospital (1984-2021). Epidemiological, clinical, and histological variables were analysed. STATISTICS: SPSS 28.0 software was used. Univariate and multivariate logistic regression analyses were performed. p < 0.05 was considered statistically significant. RESULTS: 64.71% of the cases (n = 88) presented a genetic mutation (familial cases). Additionally, 32.39% (n = 23) corresponded to index cases and the rest to screening cases. The main differences between patients with familial and sporadic PHEO were age (OR = 0.93 (0.89-0.97)), blood pressure-related symptoms (OR = 0.22 (0.06-0.89)), bilaterality (OR = 15.49 (3.76-63.84)), and size (OR = 0.70 (0.54-0.92)). Among patients with sporadic PHEO and index cases, only bilaterality was significant (OR = 13.53 (1.24-144.34)). CONCLUSIONS: Patients with familial PHEO diagnosed by screening differ from sporadic cases in terms of age, clinical features, and size. However, patients with sporadic PHEO only differ from index cases by a lower presence of bilaterality, which reaffirms the importance of genetic screening of patients with PHEO and their relatives.

Tumor microenvironment in thyroid cancer: Immune cells, patterns, and novel treatments.

The tumor immune microenvironment of thyroid cancer is the heterogeneous histological space in which tumor cells coexist with host cells. Published data from this review were identified by search and selection database of Pubmed, Elsevier, and Science Direct. Searching was made in two steps using different keywords. In thyroid pathology, the inflammatory response is very important, and might have a key role finding new diagnostic and therapeutic methods, particularly in thyroid cancer. Different immune cells may be more or less present in different types of thyroid cancer and may even have different functions, hence the importance of knowing their presence in different thyroid tumor pathologies. Cancer-related inflammation could be a useful target for new diagnostic and therapeutic strategies by analyzing peritumoral and intratumoral immune cells in different types of thyroid tumors. Moreover, novel strategies for thyroid cancer treatments, such as monoclonal antibodies targeting checkpoint inhibitors, are emerging as promising alternatives.

Incidental versus clinical diagnosis of papillary thyroid microcarcinoma. Long-term prognosis. / Diagnóstico incidental versus clínico del microcarcinoma papilar de tiroides. Pronóstico a largo plazo.

INTRODUCTION: The incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. MATERIAL AND METHODS: The study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. RESULTS: PTMC clinically diagnosed had a high frequency of hypothyroidism (4.6% vs. 18.9%; P=.004), extrathyroidal extension (5.7% vs. 17.6%; P=.018), metastatic lymph nodes (1.1% vs. 18.9%; P<.001) and lymphocytic thyroiditis (5.7% vs. 27%; P<.001). In the multivariate analysis, metastatic lymph nodes (OR: 22.011, IC 95%: 2.621-184.829; P=.004) and lymphocytic thyroiditis (OR: 4.949; IC 95%: 1.602-15.288; P=.005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119.8±65.1 months, one recurrence was detected in group 2 (0% vs. 1,4%; P=.460). No patient died due to the disease. CONCLUSIONS: PTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed.

Attitudes of Latin American Immigrants Resident in Florida (United States) Toward Related Living Kidney Donation.

INTRODUCTION: Latin American immigrants comprise an important population group in the United States. The purpose of this study was to analyze the attitude toward living kidney donation found among Latin American citizens who are residents in Florida and to identify the psychosocial variables affecting their attitude. MATERIAL AND METHODS: A sample of Latin American residents in the state of Florida was randomly obtained and stratified by nationality, age, and sex (n = 1524). Attitude was assessed through a validated questionnaire that was self-administered and completed anonymously. Descriptive, Student t test and the χ2 test were used to analyze findings. RESULTS: The questionnaire completion rate was 94% (N = 1433), with 59% (n = 845) in favor of related living donation, 40% (n = 571) were opposed to donation, with the remaining 1% (n = 17) undecided. The following variables were related to attitude toward living donation: country of origin (P < .001), marital status (P < .001), having descendants (P = .004), educational background (P < 0.001), having had previous experience of donation and transplantation (P < .001), attitude toward deceased donation (P < .001), considering the possibility of needing a transplant (P < .001), the respondent's partner's opinion (P < .001), having considered the subject with one's family (P < .001), having carried out prosocial type activities (P < .001), the respondent's religion (P < .001), knowing that one's religion is in favor of this therapy (P < .001), concern about mutilation after donation (P < .001), and considerations of the risks of living donation (P < .001). CONCLUSIONS: The attitude toward related living kidney donation of Latin American residents in Florida is not very favorable (only 59%).

The Knowledge of the Brain Death Concept Among Latin Americans Residing in Florida (USA).

OBJECTIVES: The knowledge of the concept of brain death is fundamental for being able to understand the organ donation process and helps to achieve its acceptance. Our aim was to analyze levels of understanding of the brain death concept among Latin Americans residing in Florida (USA) and to determine the factors affecting this understanding. MATERIALS AND METHODS: A sample of residents of Latin American origin in the state of Florida was randomized and stratified by nationality, age, and sex (N = 1524). Attitude was assessed using a validated questionnaire, which was self-administered and completed anonymously. For statistical analysis of descriptive data, we used t test, the chi-square test, and logistic regression analysis. RESULTS: The questionnaire completion rate was 95% (n = 1450). We found that 24% (n = 350) understood the concept of brain death, 54% (n = 777) did not understand it, and the remaining 22% (n = 323) believed it did not mean a person's death. The following variables were related to understanding this concept: (1) country of origin (P ⟨ .001), (2) sex (P = .001), (3) marital status (P ⟨ .001), (4) level of formal education (P < .001), (5) having spoken about the subject with one's family (P < .001), (6) a partner's attitude toward donation (P < .001), and (6) religion (P < .001). In the multivariate analysis, the following factors continued to be related: country of origin, level of formal education, and religion. A more positive attitude toward organ donation was found among those who understood the concept of brain death (29% vs 22%; P = .004). CONCLUSIONS: Knowledge of the concept of brain death among Latin American residents in Florida is limited, with marked differences depending on the respondent's country of origin, level of formal education, and religion.

Chyle fistula as complication of thyroid surgery in malignant pathology. / Fístula quilosa como complicación de la cirugía tiroidea en patología maligna.

INTRODUCTION: Cervical chyle fistula (CF) is exceptional, and there is no agreement on its treatment. The study objective was to assess the efficacy of conservative and surgical treatment in this condition. METHOD: Study population: Patients undergoing thyroid surgery who experience CF after the procedure. Study groups: 1) Group with conservative treatment: CF with flow rates less than 300cm3/day, late or collected in the neck; and 2) Group with surgical treatment: early CF with flow rates greater than 300 cm3/day. STUDY VARIABLES: Cure rates and rate of conversion to surgery were analyzed. RESULTS: Nine patients experienced CF. Conservative treatment was started in all of them, in 67% (n=6) with curative intent. Fifty percent of treated cases were resolved (n=3). The remaining patients were hospitalized after more than 150 days of treatment to add absolute diet and parenteral nutrition. The condition resolved in one patient, and the other two were referred for surgery. In the remaining patients (33%, n=3), surgery was indicated as the initial definitive treatment. A cervical approach, with ligature and transfixion stitch of the thoracic duct, was used. In one of the patients, who also had chylothorax, thoracoscopy was also performed. In the two patients where conservative treatment failed, cervicotomy was indicated, identifying in both the lymphatic reflux point. Fistula resolved in all operated patients. CONCLUSIONS: Conservative treatment was effective in 66% of low flow CFs. Surgery effectively and rapidly resolves fistulas with a high flow or not responding to conservative treatment.

Prophylactic thyroidectomy in multiple endocrine neoplasia 2 (MEN2) patients with the C634Y mutation: A long-term follow-up in a large single-center cohort.

BACKGROUND: Medullary thyroid carcinoma (MTC) is the main cause of death in multiple endocrine neoplasia 2A (MEN2A) patients. It is therefore important to treat this disease at an early stage. The mutation in codon 634 is considered to be associated with an aggressive clinical course, whereas the C634Y mutation may result in a more indolent course. Prophylactic thyroidectomy is performed before thyroid disease occurs. However, controversy surrounds this disease regarding levels of calcitonin (Ct) and age. In this context, few studies have investigated this mutation over a long period. OBJECTIVE: To analyze a large cohort of patients with the C634Y mutation who received prophylactic thyroidectomy. MATERIALS AND METHODS: In a group of 110 MEN2 patients, we analyzed those with the C634Y mutation who had received prophylactic thyroidectomy (absence of clinical and radiological thyroid disease) treated in a tertiary referral hospital between 1983 and 2016. MTC is related to age and Ct. Statistical analysis was performed using the χ2 test, partial correlations, and logistic regression. RESULTS: Fifty patients with a mean age of 12 ±â€¯9 years were analyzed; 56% of these had MTC (100% stage I). There was no case of hypoparathyroidism or permanent recurrent damage. MTC was associated mainly with age (OR 1.38). One 5-year-old patient presented with MTC. Mean follow-up time was 16 ±â€¯6 years, and no cases of recurrence were observed. CONCLUSIONS: Performing prophylactic thyroidectomy in patients with the C634Y mutation allows us to cure the disease without causing long-term complications. Our results support the notion that age <5 years should be a criterion for carrying out prophylactic thyroidectomy in these patients.

Evaluation of the thyroid nodule with high-resolution ultrasonography and elastography without fine needle aspiration biopsy. / Evaluación del nódulo tiroideo con ecografía y elastografía de alta resolución sin la punción-aspiración con aguja fina.

INTRODUCTION: Fine needle aspiration biopsy (FNAB) is the gold standard screening technique used in the diagnostic protocol for thyroid nodules. However, it is not free of complications. OBJECTIVE: To identify thyroid nodules in which FNAB could be avoided during the diagnostic process by means of the use of a high-resolution ultrasonography or elastography. MATERIAL AND METHOD: A prospective, non-randomized study was carried out. Single thyroid nodules and dominant nodules of multinodular goiter were included. Patients who had undergone thyroid surgery in the past were excluded. All patients underwent a high-resolution ultrasound and elastography, and, subsequently, a FNAB. We analyzed the ultrasound variables in 2D and Doppler, followed by the elastographic variables, and the results of the FNAB according to Bethesda. To correlate the data, the nodules were classified as benign or malignant. Student's t test, the Chi-square test and a logistic regression analysis were applied for the statistical analysis. RESULTS: A total of 221 thyroid nodules were analyzed, 32 of which were malignant (14%). The most predictive ultrasound findings of malignancy (P<.05) were a hypoechoic or complex echostructure (OR=11.832), the presence of microcalcifications (OR=9.637) and chaotic vascularization observed in the Doppler (OR=46.464). With regard to the elastography, elastographic patterns i and ii were seen to be associated with benignity (P=.0004 and P<.0001, respectively). When type i or ii elastography was combined with an ultrasound showing a non-hypoechoic nor complex echostructure, without microcalcifications nor chaotic vascularization in the Doppler ultrasound, 100% of the cases were benign with a specificity of 100% and a sensitivity of 14%. CONCLUSIONS: The combination of a high-resolution ultrasound with an elastography makes it possible to select cases where a FNAB does not have to be performed. Cases susceptible to a periodic follow-up without the use of a FNAB are those without a hypoechoic nor complex structure, no microcalcifications, non-chaotic vascularization and a type i or ii elastography.

Knowledge of the Concept of Brain Death Among the Latin-American Population Residing in Spain.

OBJECTIVES: The knowledge of brain death is fundamental for being able to understand the organ donation process and for ensuring its acceptance or rejection. Here, we analyzed the level of knowledge of the concept of brain death among Latin-American individuals who are residents of Spain to determine the factors affecting this knowledge. MATERIALS AND METHODS: Our patient group was a sample of 1314 Latin-American residents of Spain, obtained randomly and stratified according to the respondent's nationality, age, and sex. Their attitude was assessed using a validated questionnaire. The survey was self-administered and completed anonymously. RESULTS: The questionnaire completion rate was 94% (n = 1237). Of total respondents, 25% (n = 313) knew the concept of brain death, which they considered to be an individual's death, 56% (n = 697) did not know the term, and 19% (n = 227) believed that it did not mean death. The variables related to knowledge of the brain death concept included (1) country of origin, with a better knowledge among those with Mexican nationality (P < .001); (2) male sex (30% vs 23%; P = .003); (3) having university-level education (35% vs 23%; P = .044); (4) having discussed the matter within the family (29% vs 23%; P = .044); (5) having a partner with a favorable attitude toward donation (39% vs 21%; P = .001); and (6) the respondent's religion (47% vs 7%; P < .001). The following factors persisted in the multivariate analysis: country of origin (odds ratio of 2.972), sex (odds ratio of 1.416), education level (odds ratio of 2.228), attitude of the respondent's partner (odds ratio of 1.835), and religion (odds ratio of 4.490). CONCLUSIONS: Knowledge of the concept of brain death is limited among Latin-American residents of Spain, with marked differences among country of origin and other socio-personal factors.

The attitude of Latin American immigrants in Florida (USA) towards deceased organ donation - a cross section cohort study.

The Latin American (LA) population resident in the USA is a growing subgroup of the population. To find out the structure of attitude towards organ donation in the LA population resident in Florida (USA). A sample was taken of LA residents in Florida, randomized and stratified by nationality, age and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID-DTO Rios) that was self-completed anonymously. The survey completion rate was 95% (n = 1450). Attitude was favourable in 33% of respondents (n = 485), against in 40% (n = 575) and undecided in 27% (n = 390). The following variables were associated with a favourable attitude: country of origin (Dominican Republic; P = 0.038); sex (female; P < 0.001); marital status (married; P < 0.001); level of education (university; P < 0.001); previous experience of the subject (P < 0.001); considering the need for a transplant in the future (P < 0.001); understanding the concept of brain death (P = 0.003); attitude towards donating a family member's organs (P < 0.001); having discussed organ donation and transplantation with one's family (P < 0.001) or with one's partner (P < 0.001); participation in pro-social type activities (P < 0.001); the respondent's religion (atheist-agnostic; P < 0.001); a respondent's knowledge of the attitude of his or her religion towards organ donation (P < 0.001); no concern about mutilation after donation (P < 0.001); acceptance of cremation (P < 0.001); burial (P < 0.001); and an autopsy if one were needed (P < 0.001). The attitude towards donation of LA in Florida is worse than that reported in the native population and is associated with certain psychosocial factors.

Acceptance of living liver donation among medical students: A multicenter stratified study from Spain.

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. STUDY TYPE: A sociological, interdisciplinary, multicenter and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. SAMPLE SIZE: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. STATISTICAL ANALYSIS: Student´s t test, χ(2) test and logistic regression analysis. RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001). CONCLUSION: Spanish medical students have a favorable attitude toward LLD.

Acceptance of organ xenotransplantation among Latin American immigrants resident in the United States.

BACKGROUND: Making xenotransplantation socially acceptable is the first step in working toward the promotion of this potential therapy option for providing transplant organs. OBJECTIVE: To analyze the attitude toward xenotransplantation among the Latin American population resident in Florida (the USA), and to determine the variables affecting this attitude. METHODS: A sample of Latin American residents in the state of Florida was randomized and stratified according to nationality, age, and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID-XenoTx Rios) which was self-completed anonymously. STATISTICAL ANALYSIS: descriptive analysis, Student's t-test, the chi-square test, and a logistic regression analysis. RESULTS: The questionnaire completion rate was 95% (n = 1450). If it was assumed that xenotransplanted organs functioned as well as human ones, 10% (n = 147) would be in favor, 73% (n = 1092) against, and 17% (n = 246) undecided. If the results were worse, only 2% (n = 35) would be in favor. This favorable attitude was related to country of origin (Honduras and Guatemala; P < 0.001); age (P < 0.001); sex (women; P < 0.001); marital status (married; P < 0.001); descendents (yes; P < 0.001); level of formal education (secondary education and university; P < 0.001); participation in voluntary prosocial activities (yes; P < 0.001); having spoken about donation and transplantation within the family (yes; P < 0.001); a partner's favorable attitude toward transplantation (P = 0.040); religion (catholic; P < 0.001); knowing the attitude of one's religion toward donation (yes; P < 0.001); previous experience of donation and/or transplantation (yes; P < 0.001); a belief that one might need a transplant in the future (yes; P < 0.001); and a favorable attitude toward human donation (yes; P < 0.001). The following were associated with attitude in the multivariate analysis: age (≥40 yrs; OR = 1.152); marital status (married; OR = 500); prosocial activities (yes, I participate in them; OR = 9.196. No, but I would like to; OR = 332.538); religion (catholic; OR = 2000); attitude toward deceased organ donation (in favor; OR = 2000); and previous experience of donation and/or transplantation (yes; OR = 500). CONCLUSIONS: The attitude of Latin Americans resident in Florida toward xenotransplantation is very negative, and is determined by many psychosocial factors, mainly related to their prior attitude toward the different kinds of human organ donation.

[Concept of clientele: discourse analysis of the benevolence in the context of the Brazilian psychiatrich reform]. / Concepção de clientela: análise do discurso da benevolência no contexto da reforma psiquiátrica brasileira.

This study aims to know the dynamic and controversial which is the practice in mental health. For that, it's analyzes the discourse of workers of mental health about the concept of on the concept of the clientele of the service. The corpus of this work is composed for interviews applied to 17 of the 25 professionals of mental health who work in a service substitute of a city of the Brazilian South Region. The theoretical-philosophical referential was the Critical Discourse Análisis. The methodological device was the "axiologic-discursive diagram". The results demonstrate that the workers assume relations of benevolence because the clientele conceptual undefinition, fruit of the difficulty in establishing what is normal and pathological in mental health. We wait that the study it contributes to problematize the process of consolidation of the Brazilian psychiatric reform.

Trabalhadores em saúde mental: contradições e desafios no contexto da reforma psiquiátrica / Trabajadores del área de salud mental: contradicciones y desafíos en el contexto de la reforma psiquiátrica / Mental health workers’: contradictions and challenges in the psychiatric reform context

Este estudo analisa o discurso de trabalhadores, apontando caminhos, dúvidas e incertezas que rondam a constituição da equipe de um serviço comunitário de saúde mental. O corpus é composto por entrevistas aplicadas no ano de 2006 a 17 dos 25trabalhadores de saúde mental que trabalham em um serviço substitutivo de uma cidade da Região Sul do Brasil. O dispositivo metodológico que subsidia a sistematização dos dados é o “diagrama axiológico-discursivo”, construído a partir dos pressupostos teóricos da Análise Crítica do Discurso. Constata-se que a incerteza operacional que une e fragmenta a equipe, ao mesmo tempo,está relacionada com uma cascata de possibilidades, que se inicia na indefinição operacional dos objetos e instrumentos de trabalho em saúde mental, e termina na dificuldade de identificar quem são os profissionais que devem cuidar da loucura no serviço. Espera-se que este estudo ajude na problematização do movimento de reforma psiquiátrica no contexto brasileiro...

This study analyzes the mental health workers discourse, pointing directions, doubts and uncertainties about the formation of the community mental health service team. The corpus consists in interviews applied in 2006 to 17 of 25 mental health workers in a substitutive service in a city in southern Brazil. The methodological device which subsidizes the systematization of the data is the "axiological-discursive diagram", constructed from the Critical Discourse Analysis theoretical framework. It was found that the operational uncertainty that joins the team and its fragments at the same time, is related to a cascade of possibilities, which began operating in the very vagueness of the objects and instruments of work in mental health and ending on the difficulty of identifying who are the professionals who must take care of madness in the service. We hope this study can help in questioning the movement of psychiatric reform in the Brazilian context.

Este estudio analiza el discurso de trabajadores, señalando caminos, dudas e incertidumbres que se presentan en el proceso de constitución del equipo de una institución de servicios comunitarios de salud mental. El corpus se compone de entrevistas aplicadas en el año de 2006 a 17 de los 25 profesionales de salud mental que trabajan en un servicio sustitutivo de una ciudad de la Región Sur de Brasil. El dispositivo metodológico que subsidia la sistematización de los datos es el "diagrama axiológico-discursivo", construido a partir de los presupuestos teóricos del Análisis Crítico del Discurso. Se constató que la incertidumbre operacional que une y fragmenta, al mismo tiempo, el equipo está relacionao con una gran variedad de posibilidades, que empieza en la indefinición operacional de los objetos e instrumentos de trabajo en el área de la salud mental, y termina en la dificultad de identificar quienes son los profesionales que deben cuidar de la locura en el servicio. Se espera que este estudio pueda ayudar en la problematización del movimiento de reforma psiquiátrica en el contexto brasileño.

Concepção de clientela: análise do discurso da benevolência no contexto da reforma psiquiátrica brasileira / Concepción de clientela: análisis del discurso de la benevolencia en el contexto de la reforma psiquiatrica brasileña / Concept of clientele: discourse analysis of the benevolence in the context of the Brazilian psychiatrich reform

Este estudo pretende conhecer o contexto dinâmico e controverso onde ocorre a prática em saúde mental. Para isso, analisou-se o discurso de trabalhadores de saúde mental sobre a concepção da clientela do serviço. O corpus deste trabalho é composto por entrevistas aplicadas a 17 dos 25 profissionais de saúde mental que trabalham em um serviço substitutivo de uma cidade da Região Sul do Brasil. O referencial teórico-filosófico foi a Análise Crítica do Discurso. O dispositivo metodológico que subsidiou a sistematização dos dados foi o "diagrama axiológico-discursivo". Os resultados demonstram que os trabalhadores assumem relações de benevolência em função da indefinição conceitual sobre a clientela do serviço, fruto da dificuldade em estabelecer o que é normal e patológico em saúde mental. Esperamos que o estudo contribua para problematizar o processo de consolidação da reforma psiquiátrica brasileira.

This study aims to know the dynamic and controversial which is the practice in mental health. For that, it's analyzes the discourse of workers of mental health about the concept of on the concept of the clientele of the service. The corpus of this work is composed for interviews applied to 17 of the 25 professionals of mental health who work in a service substitute of a city of the Brazilian South Region. The theoretical-philosophical referential was the Critical Discourse Análisis. The methodological device was the "axiologic-discursive diagram". The results demonstrate that the workers assume relations of benevolence because the clientele conceptual undefinition, fruit of the difficulty in establishing what is normal and pathological in mental health. We wait that the study it contributes to problematize the process of consolidation of the Brazilian psychiatric reform.

Este estudio pretende conocer el contexto dinámico y contradictorio en la práctica de salud mental. Para eso, se ha analizado el discurso de los trabajadores de salud mental sobre la concepción de la clientela del servicio. El corpus del trabajo es compuesto por entrevistas aplicadas a 17 de los 25 profesionales que trabajan en un servicio sustitutivo de una ciudad de la Región Sur de Brasil. El referencial teórico-filosófico fue el Análisis Crítico del Discurso. El dispositivo metodológico fue el "diagrama axiológico-discursivo". Los resultados demuestran que los trabajadores asumen relaciones de benevolencia por la indefinición conceptual de la clientela, resultado de la dificultad de establecer lo que es normal y patológico en salud mental. Esperamos que este estudio pueda contribuir para problematizar el proceso de consolidación de la reforma psiquiátrica brasileña.

Equipe de saúde mental: análise do discurso sobre a prática no contexto da reforma psiquiátrica / Mental health team: discourse analysis about the practice in the psychiatric reform / Equipo de salud mental: análisis del discurso sobre la práctica en la reforma psiquiátrica

A reforma psiquiátrica vem introduzindo, no contexto brasileiro, importantes desafios para pensar a formação das equipes de saúde mental. Este estudo objetiva analisar o discurso de um trabalhador de saúde mental sobre sua própria prática, focalizando aspectos inerentes à formação da equipe para trabalhar nos serviços substitutivos. Procuramos extrair algumas dúvidas, posicionamentos ou ideologias que permeiam a inserção deste trabalhador no contexto atual do cuidado psiquiátrico. Trata-se de uma pesquisa de abordagem qualitativa, desenvolvida no ano de 2006 em um serviço substitutivo de uma cidade do sul do país. O referencial teórico-filosófico utilizado foi a análise crítica do discurso (ACD). Os resultados apontam que o contexto da Reforma Psiquiátrica é capaz de reorientar discursos e processar mudanças, ao mesmo tempo em que encontra barreiras que dificultam sua consolidação. A formação das equipes, por exemplo, já começa a incorporar conhecimentos interdisciplinares, no entanto, na prática ainda concentrada na divisão de habilidades e competências, próximas à multidisciplinaridade. Esperamos que este estudo sirva de subsídio para outros estudos na área, para compreender como, discursivamente, nossa sociedade se relaciona com o louco e a loucura, com as aproximações e os distanciamentos característicos dessa relação.

In Brazilian context the Psychiatric Reform is introducing important challenges to think about the mental health team?s education. This study aims to analyze the discourse of one mental health worker about the own practice, focusing inherent aspects to the formation of the team for working in the substitutive services. We sought to extract some doubts, positioning or ideologies that permeate the insertion of this worker in the current context of psychiatric care. This is a qualitative research, developed in 2006 at a substitutive service of a city of the southern Brazil. We used the critical discourse analysis (CDA. The results point that the psychiatric reform context is capable to reorient discourses and to process changes, at the same time where it finds barriers that difficult its consolidation. The team?s formation starts to incorporate interdisciplinary knowledge, for example. However, in the practical it is still focused in abilities and competences division, close to the multidisciplinary knowledge. We hope that this study serves as a subsidy for other studies Mental Health to enlarge, discursively, the understanding of how our society relates with the mad and madness, and with the approaches and distancing characteristic of this relationship.

La reforma psiquiátrica ha sido un importante movimiento para discutir, en el contexto brasileño, la formación de los equipos de salud mental. Este estudio pretende analizar el discurso de un trabajador de salud mental sobre su práctica, focalizando aspectos inherentes a la formación del equipo para trabajar en los servicios sustitutivos. Buscamos explotar algunas dudas, posicionamientos o ideologías que permean la inserción del trabajador en el contexto actual del cuidado psiquiátrico. Se trata de una investigación cualitativa, desarrollada en 2006 en un servicio sustitutivo de una ciudad del sur de Brasil. El referencial teórico-filosófico utilizado fue el análisis crítico del discurso (ACD). Los resultados apuntan que el contexto de la Reforma Psiquiátrica es capaz de reorientar discursos y procesar cambios, al mismo tiempo que encuentra barreras que dificultan su consolidación. La formación de los equipos, por ejemplo, ya empieza a incorporar conocimientos interdisciplinarios, sin embargo, en la práctica aún concentrándose en la división de las habilidades y competencias, cercas de la multidisciplinaridad. Esperamos que este estudio sirva de estímulo para otros estudios en el área, para comprender como, discursivamente, nuestra sociedad se relaciona con el loco y la locura, con las aproximaciones y los distanciamientos característicos de esta relación.

Serviços substitutivos de saúde mental e inclusão noterritório: contradições e potencialidades / Mental health substitutive services and inclusion in the territory:contradictions and potentialities / Servicios sustitutivos de salud mental e inclusión en el territorio:contradicciones y potencialidades

Este estudo pretende analisar o discurso de trabalhadores de saúde mental sobre a implantação dos serviçossubstitutivos no território. Objetiva-se apontar, no discurso, contradições e potencialidades da proposta, de modoa poder-se avançar nas discussões sobre o processo de consolidação da reforma psiquiátrica brasileira. Ocorpus deste trabalho constitui-se de entrevistas aplicadas a 17 dos 25 profissionais de saúde mental quetrabalham em um serviço substitutivo de uma cidade da Região Sul do Brasil. O dispositivo metodológico quesubsidiou a sistematização dos dados foi o “diagrama axiológico-discursivo”, construído a partir dos pressupostosteóricos da Análise Crítica do Discurso. Os resultados mostram que os trabalhadores parecem tentar evitar ofechamento do serviço sobre si mesmo, apesar dos movimentos contrários que reforçam a tendência aoisolamento, ao encolhimento e ao esvaziamento do território. Esperamos que este estudo possa ajudar naproblematização do movimento de reforma psiquiátrica no contexto brasileiro.

This study aims to analyze the discourse of mental health workers on the deployment of substitutive services inthe territory. The aim is to point out, in discourse, contradictions and potentialities of the proposal, in order toadvance the discussions on the consolidation process of the Brazilian psychiatric reform. The corpus of this workconsists in interviews applied to 17 of 25 mental health workers in a substitutive service of a city in southernBrazil. The methodological device which subsidized the systematization of the data was the "axiologicaldiscursivediagram", constructed from the Critical Discourse Analysis theoretical framework. The results show thatworkers seem to try to prevent the end of the service by itself, despite the contrary movements that reinforce thetendency to isolation, the reduction and a loss of territory. We hope this study can help in questioning themovement of psychiatric reform in the Brazilian context.

Este estudio pretende analizar el discurso de los trabajadores de salud mental sobre la implantación de losservicios sustitutivos en el territorio. Se busca apuntar, en el discurso, contradicciones y potencialidades de lapropuesta, para poder avanzar en las discusiones sobre el proceso de consolidación de la reforma psiquiátricabrasileña. El corpus es compuesto por entrevistas aplicadas a 17 de los 25 profesionales de salud mental quetrabajan en un servicio sustitutivo de una ciudad de la Región Sur de Brasil. El dispositivo metodológico quesubsidió la sistematización de los datos fue el “diagrama axiológico-discursivo”, construido a partir de lospresupuestos teóricos del Análisis Crítico de Discurso. Los resultados muestran que los trabajadores parecenintentar evitar el cierre del servicio sobre sí mismo, aunque haya movimientos contrarios que refuerzan latendencia al aislamiento, al encogimiento y al vaciamiento del territorio. Esperamos que este estudio puedaayudar en la problematización del movimiento de reforma psiquiátrica en el contexto brasileño.

Reforma psiquiátrica, trabalhadores de saúde mental e a "parceria" da família: o discurso do distanciamento / Psychiatric reform, mental health workers and the family's / Reforma psiquiátrica, trabajadores de salud mental y la cooperación de la familia: el discurso del distanciamiento

Este estudo analisou o discurso de trabalhadores de saúde mental sobre a participação da família no tratamento. O corpus foi composto por entrevistas aplicadas a 17 dos 25 profissionais que trabalham em um serviço substitutivo de uma cidade da região Sul do Brasil. O referencial teórico-filosófico foi a Análise Crítica do Discurso. O dispositivo metodológico que subsidiou a sistematização dos dados foi o "diagrama axiológico-discursivo". Verificou-se que os trabalhadores manifestam a importância da família no tratamento do usuário, entretanto, representação ainda pautada na responsabilização e culpabilização, quando a família se afasta do tratamento. Aos poucos, a "parceria" vai dando espaço ao "distanciamento", como dimensão cuidadora nos serviços de saúde mental. Espera-se que este estudo subsidie a constante reflexão sobre o papel das famílias em saúde mental, temática importante para repensar saberes e práticas sobre o louco, a loucura e suas relações no contexto da reforma psiquiátrica.

This study analyzed the discourse of mental health workers regarding family participation in treatment. The corpus consisted of interviews applied to 17 of the 25 professionals working in a substitutive service in a city in southern Brazil. The theoretical-philosophical framework was critical discourse analysis. The methodological device that supported the systematization of the data was the "axiological-discursive diagram". It was found that the workers expressed the importance of the family in treating user, but with representation still based on assigning responsibility and blame when the family moves away from the treatment. Gradually, the "partnership" gives way to "distancing" as a care dimension within the mental health services. It is hoped that this study will support continuing reflection on the role of families in mental health, which is an important issue in rethinking knowledge and practices relating to lunatics and madness, and their relationship within the context of psychiatric reform.

Este estudio ha analizado el discurso de los trabajadores de salud mental sobre la participación de la familia en tratamiento. El corpus se compone de entrevistas aplicadas a 17 de los 25 profesionales que trabajan en un servicio substitutivo de una ciudad de la región Sur de Brasil. El referencial teórico-filosófico ha sido el Análisis Crítico del Discurso. El dispositivo metodológico que ha subsidiado la sistematización de los datos es el "diagrama axiológico-discursivo". Se verifica que los trabajadores manifiestan la importancia de la familia en el tratamiento del usuario; sin embrago representación aún pautada en la responsabilización y culpabilización, cuado la familia se aparta del tratamiento. Poco a poco la cooperación va dando espacio al distanciamiento como dimensión cuidadora en los servicios de salud mental. Se espera que este estudio pueda subsidiar la constante reflexión sobre el papel de las familias en salud mental, temática importante para repensar saberes y prácticas sobre lo loco, la locura y sus relaciones en el contexto de la reforma psiquiátrica.