Percepções e vivências de mulheres acerca da sexualidade durante o período de amamentação / Perceptions and experiences of women about sexuality during the breastfeeding period / Percepciones y experiencias de las mujeres sobre la sexualidad durante el período de lactancia materna

Objetivo: apreender como as mulheres percebem e vivenciam a sexualidade durante o período da amamentação. Método: estudo descritivo de abordagem qualitativa, realizado com mulheres lactantes ou que já haviam amamentado, em seis Unidades Básicas de Saúde de município da região Sul do Brasil. Os dados foram coletados no período de maio a agosto de 2018, mediante entrevistas semiestruturadas, áudio-gravadas, realizadas em local reservado nas unidades de saúde. As informantes foram 18 mulheres com filhos de até 12 meses de vida, que estava sendo ou tivesse sido amamentado ao seio por algum tempo, e que compareceram à Unidade de Saúde para puericultura ou consulta com pediatra durante o período da coleta de dados. Foram excluídas as mulheres que referiram não ter iniciado a prática sexual no período de amamentação. Os dados produzidos foram submetidos à análise de conteúdo modalidade temática. Resultados: as mulheres percebem e vivenciam a sexualidade durante a amamentação por meio de mudanças na autoimagem, na autoestima e no relacionamento com o parceiro. As modificações mamárias foram bem percebidas no período gestacional e no início da amamentação, porém, com o decorrer do tempo, algumas mulheres as perceberam de forma negativa, sobretudo aquelas que tiveram mais dificuldade na retomada do peso pré-gravídico. Os resultados mostraram também que as mulheres passaram por um período de incertezas e inseguranças em relação a sexualidade e que mudanças da dinâmica conjugal foram necessárias neste período de transição para o exercício da sexualidade, considerando necessidades do suporte nutricional e afetivo do bebê. Conclusão: as mulheres percebem e vivenciam dificuldades em conciliar a sexualidade com a amamentação, visto que a nova dinâmica familiar decorrente do nascimento de um filho, associada as alterações na estética corporal, podem repercutir de forma negativa na sexualidade.(AU)

Objective: To understand how women perceive and experience sexuality during the breastfeeding period. Method: Descriptive study with a qualitative approach carried out with lactating women or women who had already breastfed, having as field of study six Basic Health Units (UBS) of a municipality in the southern region of Brazil. Data were collected from May to August 2018, through semi-structured interviews, audio-re-corded and held in a reserved place at the UBS. The informants were 18 women with children aged up to 12 months who were being or had been breastfed for some time and who attended the UBS for childcare or consultation with a pediatrician during the pe-riod of data collection. Women who reported not having started sexual practice during the breastfeeding period were excluded. The data produced were submitted to content analysis ­ thematic modality. Results: Women perceive and experience sexuality du-ring breastfeeding through changes in self-image, self-esteem, and relationship with the partner. Breast changes were well perceived during the gestational period and at the beginning of breastfeeding; however, over time, some women perceived the changes in a negative way, especially those who had more difficulty regaining their pre-pregnancy weight. The results also showed that the women went through a period of uncertain-ties and insecurities in relation to sexuality and that changes in the marital dynamics were necessary in this transition period for the exercise of sexuality, considering the nutritional and affective support needs of the baby. Conclusion: Women perceive and experience difficulties in reconciling sexuality with breastfeeding, since the new family dynamics resulting from the birth of a child and changes in body aesthetics can have a negative impact on sexualit.(AU)

Objetivo: aprender cómo las mujeres perciben y viven la sexualidad durante el período de la lactancia materna. Método: estudio descriptivo con abordaje cualitativo, realizado con mujeres lactando o que ya habían lactado, en seis Unidades Básicas de Salud de un municipio de la región sur de Brasil. Los datos fueron recolectados en el período de mayo a agosto de 2018, a través de entrevistas semiestructuradas y grabadas en audio, realizadas en un lugar reservado en las unidades de salud...(AU)

Abertura à experiência e preferência em obras de arte figurativas e não figurativas / Opening to experience and preference for figurative and non-figurative works of art / Apertura a la experiencia y preferencia por obras de arte figurativas y no figurativas

A arte não representacional é outra maneira de aludir à arte abstrata, sendo um estilo no qual os objetos não se parecem com aqueles que se apresentam na natureza física concreta. No último século, foram realizadas investigações experimentais sobre estética e personalidade objetivando revelar fatores contribuintes para as diferenças quanto às preferências artísticas. Este estudo explorou as associações entre abertura à experiência e preferência por arte visual. Os participantes completaram a Escala Fatorial de Abertura e classificaram a preferência por quatro imagens diferentes correspondentes à arte representativa e não representativa. A análise estatística dos dados revelou uma correlação positiva entre o fator Fantasia e a apreciação pelas pinturas abstratas (r =.20). Não foi verificada uma correlação estatisticamente significativa entre essa dimensão e a apreciação de pinturas figurativas. Embora esses achados sejam exploratórios, outras medidas mais completas relacionadas às diferenças individuais e preferências artísticas poderão ser utilizadas em novos estudos no Brasil.

Nonrepresentational art is another way to refer to abstract art elating to a style in which objects do not resemble those known in physical nature. In the last hundred years some experimental investigations of aesthetics and personality have been conducted to reveal fundamental factors which contribute to differences in artistic preference. This study explored associations among openness to experience and preference for visual art. Participants completed an Openess Fatorial Scale and provided preference ratings for different paintings corresponding to representational and nonrepresentational art. The statistical analysis of the data showed a positive correlation between the fantasy factor and appreciation for abstract paintings (r =.20). Here was no statistically significant correlation between this same dimension and the appreciation for figurative paintings. Although these findings are somewhat exploratory and more comprehensive measures of individual differences and art preferences could be employed in new studies in Brazil.

El arte no representacional es otra forma de referirse al arte abstracto que se adapta a un estilo en el que los objetos no se parecen a los que se conocen en la naturaleza física concrecta. En el siglo se han llevado a cabo investigaciones experimentales sobre estética y personalidad para revelar los factores contribuintes a las diferencias en preferencias artísticas. Los participantes completaron una Escala Fatorial de Abertura a experiencia y otorgaron calificaciones de preferencia para 4 diferentes images correspondientes al arte representativa y no representativa. El análisis estadístico de los datos mostró correlación entre el factor fantasía y y la apreciación de pinturas abstractas (r =.20). No fue verificada una correlación estadísticamente significativa entre esta dimension y la apreciación de las pinturas figurativas. Aunque estos hallazgos son exploratorios y podrían emplear medidas más completas de diferencias individuales y preferencias artísticas en nuevos estudios en Brasil.

Uma reflexão sobre a fenomenologia da experiência estética: o caso do teatro / Reflecting on the phenomenology of aesthetic experience: the case of theater / Una reflexión sobre la fenomenología de la experiencia estética: el caso del teatro

A arte, por se tratar de um tema fundamentalmente humano, mostra-se como campo de estudos importante à filosofia e à psicologia. Considera-se relevante pensá-la sob o viés da fenomenologia, que compreende a atividade artística não como representação, mas como expressão. Por meio deste estudo, objetiva-se refletir acerca da atividade do ator/da atriz de teatro a partir da obra Phénoménologie de l'experience esthétique, principal produção de Mikel Dufrenne, fenomenólogo que escreveu o mais extenso estudo a respeito da estética em fenomenologia. Essa tarefa se realiza em duas etapas: uma possível explanação a respeito da experiência estética tal como proposta por Dufrenne e, a partir dela, a construção de uma reflexão a respeito do trabalho do artista de teatro. Fica evidente o papel que a arte e, sobretudo, o artista tem na ressignificação do mundo, ao ser ele quem oferece ao espectador, por meio de uma intersubjetividade imanente, um mundo expresso como novidade. Entende-se que, para além do estudo de temas específicos, o estudo da experiência estética em fenomenologia, a partir da ótica dufrenniana, pode se mostrar relevante para a compreensão do fenômeno humano em sua generalidade.

Art, a fundamentally human subject, has become an important field of study in both philosophy and psychology. It is deemed relevant to think of it from a phenomenological perspective, that regards artistic activities not as a representation, but as an expression. This study aims to consider the actor's/actress's activities based on the book Phénoménologie de l'experience esthétique, the main work by Mikel Dufrenne, a phenomenologist who wrote the most extensive study regarding aesthetics in phenomenology. This task has been accomplished in two stages: a possible explanation about the aesthetic experience as proposed by Dufrenne and, from it, the construction of a reflection about a theater artist's work. The role that art and, above all, the artist plays in the resignification of the world becomes evident, as he is the one who offers the viewer, through an immanent intersubjectivity, a world expressed as a novelty. It is understood that, in addition to the study of specific topics, the study of aesthetic experience in phenomenology, from the Dufrennian perspective, may prove relevant to the comprehension of the human phenomenon in general.

El arte, un tema fundamentalmente humano, se ha convertido en un importante campo de estudio tanto para la filosofía como para la psicología. Se considera relevante pensarlo desde una perspectiva fenomenológica, que considera las actividades artísticas no como representación, sino como expresión. Este estudio tiene como objetivo reflexionar sobre las actividades del actor/actriz, basado en la obra Phénoménologie de l'experience esthétique, el trabajo principal de Mikel Dufrenne, un fenomenólogo que escribió el estudio más extenso acerca de la estética en fenomenología. Esta tarea se realizó en dos etapas: una posible explicación sobre la experiencia estética propuesta por Dufrenne y, a partir de ella, la construcción de una reflexión sobre el trabajo de un artista teatral. El papel que desempeña el arte y, sobre todo, el artista en la resignificación del mundo se hace evidente, ya que él es que ofrece al espectador, a través de una intersubjetividad inmanente, un mundo expresado como novedad. Se entiende que, además del estudio de temas específicos, el estudio de la experiencia estética en fenomenología, desde la perspectiva dufreniana, puede resultar relevante para la comprensión del fenómeno humano en general.

Breve discurso sobre ética, moral, estética e bioética das relações / Brief speech on ethics, moral aesthetics and bioethics relationship / Breve charla sobre ética, moral, estética y bioética de las relaciones / Bref discours à propos de l'éthique, de la morale, de l'esthétique et de la bioéthique des relations

A proposta deste trabalho é rever os conceitos de ética, moral e estética, e articulá-los com os princípios da bioética das relações, que carregam intrinsecamente princípios psicanalíticos. O ser humano constrói seus valores morais no processo de socialização. A estética como qualidade do sentir, proposta por Freud, não passa pela razão. O senso estético é o que nos possibilitará interpretar o mundo externo e os valores morais ou da cultura. Enquanto "a moral vem de fora, a ética parte de dentro". Assim, diferenciamos os conceitos respectivamente como funções do superego e do ego. A forma ética de lidar com os conflitos das relações humanas dar-se-á com um acordo entre a autonomia individual e a responsabilidade social. A máxima da bioética das relações é a "autonomia responsável". O pensamento ético é a conciliação entre os valores morais internalizados e os sentimentos gerados pela percepção do indivíduo sobre a realidade frente às relações humanas. Assim, diante dos conceitos expostos, concluímos que a ética é a estética da moral.

This paper aims at reviewing the concepts of ethics, moral and aesthetics and articulating them with the principles of bioethics relationship which inherently carry psychoanalytic principles. Human beings build moral values within socialization process. Aesthetics as a feeling quality, proposed by Freud, does not go through reason. Aesthetic senses are what enables reading the external world and moral or cultural values. While "moral comes from outside, ethics comes from the inside", thus it is possible to differentiate the concepts, respectively, as functions of superego and ego. An ethical way of dealing with conflicts of human relationships will happen with an agreement between individual autonomy and social responsibility. The maxim of bioethics relationship is "responsible autonomy". The ethical thought is the conciliation between internalized moral values and the feelings generated by the individual perception about reality within human relationships. Thereby, it is possible to state that ethics is the moral aesthetics.

El propósito de este trabajo es revisar los conceptos de ética, moral y estética y articularlos con los principios de la bioética de las relaciones, que son portadores inherentes de principios psicoanalíticos. El ser humano construye sus valores morales en el proceso de socialización. La estética como cualidad del sentimiento, propuesta por Freud, no pasa por la razón. El sentido estético es el que nos permitirá interpretar al mundo exterior y sus valores morales o culturales. Mientras que "la moralidad viene de afuera, la ética viene de adentro"; así diferenciamos los conceptos respectivamente como funciones del superyó y del yo. La forma ética de abordar los conflictos en las relaciones humanas ocurrirá con la alianza entre la autonomía individual y la responsabilidad social. La moral propuesta por la bioética de las relaciones es la de una "autonomía responsable". El pensamiento ético se dará por la conciliación entre los valores morales internalizados y los sentimientos que genera la percepción de la realidad en las relaciones humanas. Así, a la vista de los conceptos expuestos, concluimos que la ética es la estética de la moral.

Ce travail a pour but de revoir les concepts d'éthique, de morale et d'esthétique et de les articuler aux principes de la bioéthique des relations, qui portent intrinsèquement des principes psychanalytiques. L'être humain construit ses valeurs morales dans le processus de la socialisation. L'esthétique comme qualité du sentir, proposée par Freud, ne passe pas par la raison. Le sens esthétique, c'est ce qui nous permettra d'interpréter le monde extérieur et les valeurs morales ou issues de la culture. Alors que « la morale vient de l'extérieur, l'éthique vient de l'intérieur ¼ ; ainsi, nous différencions ces concepts respectivement en tant que fonctions du super ego et de l'ego. La manière éthique de traiter les conflits des relations humaines sera convenue entre l'autonomie individuelle et la responsabilité sociale. La maxime de la Bioéthique des Relations est « l'autonomie responsable ¼. La pensée éthique est la conciliation entre les valeurs morales intériorisées et les sentiments générés au moyen de la perception, par l'individu, de la réalité face aux relations humaines. Ainsi, étant donné les concepts exposés, nous concluons que l'éthique est l'esthétique de la morale.

Estudo controverso permitiu a Freud pensar a psicanálise com Da Vinci: psicanálise aplicada, psicanálise implicada / Controversial study allowed Freud to think about Psychoanalysis with Da Vinci: applied psychoanalysis, implied psychoanalysis / Un estudio polémico permitió a Freud elaborar el psicoanálisis con Da Vinci: psicoanálisis aplicado, psicoanálisis implicado / Une étude controversée a permis à Freud d'élaborer la psychanalyse avec Da Vinci: psychanalyse appliquée, psychanalyse impliquée

No ensaio "Leonardo da Vinci e uma lembrança da sua infância", Freud abriu um campo de implicações entre psicanálise, arte e estética da recepção, evidenciando uma maneira de trabalhar e pensar que permite interrogar o método psicanalítico nos estudos dedicados à arte, assim como na clínica.

In the essay on "Leonardo da Vinci and a memory of his childhood", Freud opened a field of implications between psychoanalysis, art and aesthetics of reception, showing a way of working and thinking that allows for question on the psychoanalytical method in studies dedicated to art, as well as in the clinic.

En el ensayo "Un recuerdo infantil de Leonardo da Vinci", Freud abrió un campo de implicaciones entre el psicoanálisis, el arte y la estética de la recepción, mostrando una forma de trabajar y pensar que permite cuestionar el método psicoanalítico en los estudios dedicados al arte, así como en la clínica.

Dans l'essai sur « Un souvenir d>enfance de Léonard de Vinci ¼ (1910), Freud a ouvert une voie d'implications entre la psychanalyse, l'art et l'esthétique de la réception, démontrant une manière de travailler et de penser qui permet d'interroger la méthode psychanalytique dans les études consacrées à l'art, bien que dans la clinique.

Evaluation of Surgical Outcome in Rhinoplasty: A Comparison Between Rasp and Osteotome in Dorsal Hump Removal.

Dorsal hump reduction is a crucial point of rhinoplasty, as it has a great impact on the final shape of nasal pyramid. Depending on morphological features of the hump, its removal is usually obtained by the use of an osteotome or a rasp. In our study, we describe a closed rhinoplasty technique performed in 2 groups of patients: the only difference between the groups is the surgical tools used during the dorsal hump removal phase (rasp vs the 5-mm osteotome).We used 2 questionnaires of quality of life (QoL), Nasal Obstruction Symptom Evaluation (NOSE), and Rhinoplasty Outcome Evaluation (ROE) questionnaire, to evaluate postoperative outcome (6 months after surgery).Closed rhinoplasty was performed in 107 patients. Dorsal hump removal was carried out with rasp on 35 patients; while in 72 cases, it was performed using a 5-mm osteotome. All the patients were given 2 copies of NOSE and ROE questionnaires (1 month before surgery and 6 months after surgery) to evaluate postoperative QoL. In our study emerged that the use of osteotome in dorsal hump reduction is associated with a better aesthetic outcome (evaluated by analyzing patients QoL with ROE questionnaire) without any difference between the 2 groups in terms of functional outcome (expressed by NOSE questionnaire), major and minor complications and surgical procedure duration.

Assessing Unrealistic Expectations in Clients Undertaking Minor Cosmetic Procedures: The Development of the Aesthetic Procedure Expectations Scale.

Objective: To develop and validate a novel patient-reported measure to assess internally and externally driven expectations for change after a cosmetic procedure, termed the aesthetic procedure expectations (ASPECT) scale. Method: In total, 186 adults recruited from nonsurgical cosmetic clinics in Melbourne, Australia, accessed an online survey (150 completed; 81% response rate) including the novel ASPECT questionnaire, demographics, and measures of psychological distress. Results: The final sample included 141 women and 5 men with a mean age of 44.78 years (standard deviation = 11.68) with <10% missing data. Results supported a two-factor ASPECT scale measuring intrinsic and extrinsic expectations, with high internal consistency and convergent validity. Heightened extrinsic and intrinsic expectations were both associated with individuals who were emotionally distressed, younger, and had previously undertaken more cosmetic procedures. Cutoff scores for the ASPECT subscales are proposed to aid cosmetic practitioners in identifying clients requiring further assessment. Conclusions: The ASPECT scale may provide a reliable and useful clinical tool for cosmetic practitioners to assess unrealistic expectations and determine which clients may require more in-depth consultation before undergoing surgical or nonsurgical cosmetic treatment.

Patient-reported outcome measures in external and endonasal functional septorhinoplasty - A propensity score matching study.

PURPOSE: Patient satisfaction after functional-aesthetic SRP (faSRP) is highly influenced by the cosmetic result of the surgical procedure. Studies that directly evaluate aesthetic success after external and endonasal faSRP are scarce. The objective of this prospective propensity score matching study was to compare patient-reported satisfaction regarding aesthetic perception following faSRP using the external and endonasal approach in a single-institution single-surgeon survey. MATERIALS AND METHODS: Out of 161 patients operated by the senior author between October 2011 and March 2017, propensity score matching (PSM) computed 54 patients each following external (group 1) or endonasal faSRP (group 2). Patients reported their satisfaction with the aesthetic appearance of the nose on a visual analogue scale (VAS, 0-10) and five Likert scale questions using the Utrecht questionnaire three and twelve months after surgery. RESULTS: The mean preoperative VAS score of 3.46 ± 1.06 improved significantly in all patients after faSRP to 4.54 ± 0.38 (F(1.69;157.04) = 634.01, p < 0.001). The VAS increase did not show any correlation to the surgical approach (F(1;93) = 1.12, p = 0.293). The mean aesthetic sum score (5 = low burden up to 25 = high burden) improved significantly from 13.89 ± 3.78 to 8.46 ± 3.63 after three months (t(95) = 14.021, p < 0.001) and remained almost unchanged after 12 months (8.10 ± 3.76; t(98) = 1.450, p = 0.150) irrespective of the surgical approach (F(1,544;143,587) = 0.126, p = 0.829). CONCLUSIONS: Both the external and endonasal faSRP allowed for significant improvement in patient's aesthetic self-assessment of similar extent.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Pensamento Interpretativo de Freud Diante de uma Estética da Negatividade: Algumas Notas para Aproximação / Freud's Interpretative Thinking in Front of an Aesthetic of Negativity: Some Notes for Approachment / Pensamiento Interpretativo de Freud Frente a una Estética de la Negatividad: Algunas Notas para Aproximación

Lançar mão de um regime estético que preza pela forma e que é pautado na negatividade é procurar romper com a sistematicidade e o autocoerente. Voltando-se à não-identidade e prescindindo de aspirações totalitárias de compreensão da obra, esse modelo de aproximação da arte tem seu rigor pautado num inacabado, num estar em constante transformação, num ser constituído pelo saber e o não-saber, conferindo à obra de arte um status de autonomia, autenticidade e singularidade. A partir disso, o artigo tem como objetivo investigar como a concepção de interpretação da arte sustentada por esse regime estético pode ser capaz de respaldar uma virada no pensamento interpretativo de Freud - este comumente colocado num lugar de utilização da arte para validar conceitos psicanalíticos. Conclui-se que é a partir de fenômenos que destoam que se pode localizar a potencialidade, o que leva a interpretação freudiana a tomar novos rumos. Olhando para seus textos como se olha para uma obra de arte - com atenção aos detalhes - é possível a emergência de um Freud repaginado. (AU)

To be used of an aesthetic regime which appreciate shape, and it's based on negativity, is to seek to break the systematicity and the self coherent. Turning to the non-identity and sparing of totality aspirations of art understanding, this model of art approachment has its rigor based on an unfinished, in a way of constant transformation, in a being constituted by knowledge and non-knowledge, conferring to the masterpiece a status of autonomy, authenticity and uniqueness. Therefore, the article aims to investigate how the conception of art interpretation sustained by this aesthetic regime may be able to support a turn up in Freud interpretative thinking - this usually placed in a place of art use to validate psychoanalytic concepts. It is concluded that it is from the phenomena that clash that the potentiality can be located, which leads the freudian interpretation to take new directions. Looking at his texts as you look at a masterpiece - with attention to details ­ it is possible the emerge of a new on Freud. (AU)

Aprovecharse de un régimen estético que valora la forma y que es pautado en la negatividad es tratar de romper con la sistematicidad y el autocoherente. Inclinándose a la no identidad y prescindiendo de aspiraciones totalitarias de comprensión de la obra, ese modelo de aproximación del arte tiene su rigor pautado en un inacabado, en un estar en constante transformación, en un ser constituido por el saber y el no-saber, confiriendo a la obra de arte un estatus de autonomía, autenticidad y singularidad. A partir de eso, el artículo tiene como objetivo investigar cómo la concepción de interpretación del arte sostenida por ese régimen estético puede ser capaz de respaldar un giro en el pensamiento interpretativo de Freud - este comúnmente colocado en un lugar de utilización del arte para validar conceptos psicoanalíticos. Se concluye que es a partir de fenómenos que desentonan que se puede localizar la potencialidad, lo que lleva a la interpretación freudiana a tomar nuevos rumbos. Mirando sus textos como se mira a una obra de arte -con atención a los detalles- es posible la emergencia de un Freud repaginado. (AU)

Secondary "Hybrid Reconstruction" Concept with Silicone Implants After Autologous Breast Reconstruction - Is It Safe and Reasonable?

BACKGROUND The use of autologous tissue for breast reconstructive surgery following mastectomy has become routine and allows for excellent symmetry and aesthetic results. However, in some cases, the amount of tissue available from the utilized flaps is not enough to achieve the desired outcome. The use of autologous fat grafting, as well as other techniques, has been described to deal with such problems. However, though well-established, these techniques may also fail to achieve the desired results. The aim of this study was to highlight the opportunity to improve aesthetic results using a secondary prosthesis underneath the previously used free flap and to examine whether this is a safe and reasonable procedure. MATERIAL AND METHODS In our study we included patients with unsatisfied aesthetic results after free flap procedures (DIEP, S-GAP, TMG, and FCI) between 2011 and 2018. In each case described, a secondary prosthesis was placed underneath the original flap in order to improve symmetry, shape and projection. Patient age, indication for surgery, adjuvant therapy, complications and outcomes have been registered. A 12-point scale was established to analyze patient satisfaction and aesthetic outcome. RESULTS Overall "operative success" was achieved in all 13 patients (14 flaps) evaluated. At 12 months after reconstruction, all aesthetic scores collected were between good and excellent. In contrast to other studies, we chose a secondary approach for the flap augmentation and we used the epipectoral pocket for the placement of the implant. In our series, low rates of early and late post-operative complications were observed, with a high overall rate of satisfaction. CONCLUSIONS The demonstrated "Hybrid Breast Reconstruction" approach, using an implant underneath a free flap autologous breast reconstruction, provided a safe and reliable option to optimize breast reconstruction outcomes.

The Correlation of Aesthetic Plastic Surgery With Sexual, Social, and Romantic Life in Cyprus.

During the 21st century, the interest in cosmetic surgery has dramatically increased. Aesthetic plastic surgery can improve self-esteem and self-confidence, enhancing appearance, social relations, and sexual life. This study aimed to investigate the correlation of aesthetic plastic surgery with sexual, social, and romantic lives in Cyprus. Questionnaire data from 128 cosmetic surgery patients, from a plastic surgery clinic in Nicosia, were obtained approximately 1 week before and 3 months after surgery. The questionnaire was developed by the authors for the purpose of this study and consisted of measures on body image, social life, relationships, and sexuality. Pre- and postoperative values were compared. The majority of participants were women (81.9%), and respondents' mean age was 35.35 years. One of 2 participants reporting had undergone breast augmentation (47.6%). One of 2 participants reported feeling self-confidence after treatment, and the majority of respondents reported a positive influence in all 3 realms: sex life (54.7%), social life (64.4%), and romantic relationship (49.5%). Those who underwent breast augmentation were 4 times more likely to report that their sex life had been positively affected than those who did not undergo breast augmentation. The study provides evidence of improvement in an individual's satisfaction with his or her body image and self-confidence after cosmetic surgery. The study demonstrates the positive impact of cosmetic surgery to social life and relationships, especially breast augmentation surgery to sexuality.

A Prospective Study of Cosmetic Outcomes for Patients Treated with Breast Conservation and Radiation Therapy using Shorter Fractionation Schedules at Auckland Hospital, New Zealand.

AIMS: Breast cosmesis is an important outcome for women after breast conservation. It has been shown to be correlated with better patient satisfaction, sexuality and self-esteem. This study reports the subjective and objective breast cosmesis outcomes for women treated at Auckland Hospital Radiation Oncology Department using hypofractionated radiation therapy. MATERIALS AND METHODS: Breast cosmesis was evaluated using a subjective questionnaire and standardised photographs before radiation, at 6 weeks, 1 year, 3 years and 5 years after radiation. Objective evaluation of the photographs and completion of questionnaires were undertaken by clinicians at the same time points. The questionnaire evaluated global cosmesis on a four-point scale - excellent (E), good (G), fair (F) and poor (P). Patient, tumour and treatment factors were evaluated to assess the impact on cosmesis. RESULTS: Three hundred and fifty-eight patients completed the baseline assessments and two hundred and two patients completed the 5-year assessments. Sixty-eight per cent of patients at baseline and 70% at 5 years scored their cosmesis as E/G compared with 52% and 51%, respectively, by clinician assessment. Age >50 years, separation ≤25 cm, non-diabetic, T1 tumours, node negative, quadrant of the scar, no boost and no adjuvant endocrine therapy were correlated with E/G cosmesis. On multivariate analysis at baseline, the individual breast factors that were significantly associated with a score of E/G cosmesis were breast shape (P = 0.028) and scar appearance (P = 0.001). At 5 years, breast shape (P = 0.003), nipple shape (P = 0.019) and scar appearance (P = 0.001) were found to be significant. CONCLUSION: This study shows that most women reported no significant change in their breast cosmesis after hypofractionated radiation treatment over 5 years and that a number of patient, tumour and treatment factors may impact on breast cosmesis.

Experiências e apontamentos para a pesquisa em psicologia baseada nas artes / Experiencias y apuntes para la investigación en psicología basada en las artes / Experiences and notes for research in arts-based psychology

Resumo A proposta deste artigo é pensar a criação de um campo híbrido de pesquisa/experimentação na intersecção entre arte contemporânea e psicologia. Nesse sentido, exploramos o eixo arte/experiência, na intenção de produzir linhas singulares e sensíveis de subjetivação, mais afeitas ao devir e aos fluxos do que a identidades fixas. Enquanto sujeitos/pesquisadores/artistas, nossa proposta foi criar metáforas, experiências, imagens de pensamento e rasgos no que nos chega pronto, a partir da elaboração de uma figuração híbrida/plástica de corpo/subjetividade. Este foi o meio que encontramos para dar passagem para diferentes superfícies intensivas. Para tanto, valemo-nos da Metodologia de Pesquisa Baseada nas Artes e de conceitos como figuração, conexões parciais, saberes localizados (Haraway, 1995, 2013), subjetividade estética (Rolnik, 2002; Teixeira, 1993), lógica da sensação (Deleuze, 2002), entre outros.

Resumen La propuesta de este artículo es pensar la creación de un campo híbrido de investigación/experimentación en la intersección entre psicología y arte contemporáneo. En este sentido, exploramos el eje arte/experiencia, con el fin de producir líneas singulares y sensibles de subjetivación, más acostumbradas al devenir y a los flujos que a las identidades fijas. Como sujetos/investigadores/artistas, nuestra propuesta fue crear metáforas, experiencias, imágenes de pensamiento y rasgos de aquello que nos llega listo, desde la elaboración de una figuración híbrida/plástica de cuerpo/subjetividad. Este fue el medio que encontramos para dar paso a diferentes superficies intensivas. Con este fin, nos basamos en la metodología de investigación basada en las artes y conceptos tales como figuración, conexiones parciales, conocimiento situado (Haraway, 1995, 2013), subjetividad estética (Rolnik, 2002; Teixeira, 1993), lógica de la sensación (Deleuze, 2002), entre otros.

Abstract The aim of this article is to consider the creation of a hybrid research/experimentation field at the intersection of contemporary art and psychology. In this sense, we explore the art/experience axis, with the intention of producing singular and sensitive lines of subjectivation. Lines that are more akin to becoming and to the flows than to fixed identities. While individuals/researchers/artists, our proposal was to create metaphors, experiences, images of thoughts and tears in what come to us as ready-made by creating a hybrid figuration/plastic body/subjectivity. This was the way we found to make different intensive surfaces flow. To do so, we followed the Arts Based Research Methodology, and concepts such as figuration, partial connections, located knowledges (Haraway, 1995; 2013), aesthetic subjectivity (Teixeira, 1993; Rolnik, 2002), the logic of sensation (Deleuze, 2002), among others.

A irrepetibilidade da arte / The unrepeatability of art / Linimitabilité de lart / La irrepetibilidad del arte

Resumo O artigo trata dos elementos ligados à repetição como característica da intencionalidade estética nas obras de arte. Mostramos como a repetição, acompanhada da reflexão freudiana acerca do estranho (Unheimlich), é evidenciada na necessidade do artista de repetir um novo encontro com a obra, na intenção de produzir um novo encontro com o mais radical de si. Ilustramos esta ideia com os aportes trazidos pela teoria estética contemporânea de Jacques Derrida e Georges Didi-Huberman, que observam o fenômeno da desvalia (désaisissement), certa restrição de visibilidade que causa uma cegueira do objeto. Apresentamos uma breve resenha clínica sobre um caso atendido por nós em que a vivência de emoções é obstaculizada, favorecendo o aparecimento de uma fala repetida na dimensão da clínica.

Abstract This article analyzes elements that function as repetitions in pieces of art. We demonstrate how repetition, together with Freud's concept of the uncanny (Unheimlich) can be seen in the artist's need to have a new encounter with the same piece in order to once again meet what is most radical in oneself. We utilize the contemporary aesthetic theory of Jacques Derrida and Georges Didi-Huberman as theoretical framework, as they observe the phenomenon of devaluation (désaisissement), which is an impossibility of visibility that causes a blindness towards the object. We present a brief clinical review of a case we dealt with wherein the experience of emotions is hampered, favoring the appearance of a repeated speech in the clinic.

Résumé L'article traite des éléments liés à la répétition comme une caractéristique de l'intentionnalité esthétique dans les œuvres d'art. Nous montrons comment la répétition, accompagnée de la réflexion freudienne sur l'étrange (Unheimlich), se manifeste dans le besoin de l'artiste de répéter une nouvelle rencontre avec l'œuvre, afin de produire une nouvelle rencontre avec le plus radical de lui-même. Nous illustrons cette idée avec les contributions apportées par la théorie esthétique contemporaine de Jacques Derrida et Georges Didi-Huberman, qui observent le phénomène de dessaisissement, une certaine impossibilité de visibilité qui provoque une cécité de l'objet. Nous présentons une brève revue clinique d'un cas que nous avons traité dans lequel l'expérience des émotions est entravée, favorisant l'apparition d'un discours répété dans la dimension de la clinique.

Resumen El artículo aborda los elementos vinculados a la repetición como característica de la intencionalidad estética en las obras de arte. Se plantea cómo la repetición, acompañada de la reflexión freudiana acerca del extraño (Unheimlich), se evidencia en la necesidad del artista de repetir un nuevo encuentro con la obra, con la intención de producir un nuevo encuentro con el más radical de sí. Para ello, se utilizó los aportes de la teoría estética contemporánea de Jacques Derrida y Georges Didi-Huberman, quienes observan el fenómeno de desapoderamiento (désaisissement), una restricción de la visibilidad que produce una ceguera del objeto. Se presenta una breve reseña clínica sobre un caso atendido en que la vivencia de emociones es obstaculizada, favoreciendo la aparición de un habla repetida en la dimensión de la clínica.

Autocuidado en mujeres de mediana edad con obesidad / Self-care in middle-aged women with obesity

RESUMEN Introducción: El énfasis del autocuidado recae en la responsabilidad de la persona sobre su propia salud y enfermedad. Los cuidados brindados a si mismo desde el punto de vista físico, psicológico y social resultan pertinentes ante la prevalencia creciente de enfermedades crónicas no transmisibles como la obesidad, que va más allá de una cuestión estética y ocasiona graves consecuencias para la salud. Objetivo: Caracterizar la dimensión física, psicológica y social del autocuidado en mujeres de mediana edad con obesidad que se atienden en el Instituto Nacional de Endocrinología. Métodos: Se realizó un estudio exploratorio-descriptivo con una metodología cualitativa, haciendo uso del método de estudio de casos múltiples y la integración de diferentes técnicas. Se realizó un análisis de contenido que permitió identificar regularidades y rupturas entre los casos de estudio. Fueron considerados y aplicados los aspectos éticos. Resultados: Se encontró que el conocimiento de la enfermedad, la ausencia de hábitos nocivos y el buen control de la salud, fueron los aspectos del autocuidado físico más promovidos. Se mostró un pobre desarrollo del autocuidado psicológico mediante un afrontamiento pasivo de la enfermedad, emociones negativas e insatisfacción con la imagen corporal que afectaba la esfera autovalorativa, junto a una escasa proyección futura. El autocuidado social se vio favorecido por la red de apoyo familiar y las actividades en el tiempo libre. Conclusiones: Las dimensiones física y social del autocuidado son las más atendidas por las mujeres, en cambio, la psicológica es la de mayor vulnerabilidad(AU)

ABSTRACT Introduction: The emphasis of self-care lies in the responsibility of each person on their own health and diseases. The self-care given from the physical, psychological and social perspectives are relevant in view of the increasing prevalence of chronic non-communicable diseases such as obesity, which goes beyond an aesthetic issue and causes serious health consequences. Objective: To characterize the physical, psychological and social dimensions of self-care in middle-aged women with obesity, that are treated in the National Institute of Endocrinology. Methods: It was carried out a descriptive exploratory study with a qualitative methodology by using the method of multiple case studies and the integration of different techniques. It was conducted an analysis of content that made possible to identify regularities and ruptures between the cases of study. The ethical aspects were considered and applied. Results: It was found that the knowledge of this disease, the absence of harmful habits and the good control of health were the most promoted physical aspects of self-care. It was shown a poor development of psychological self-care through a passive coping with the disease, negative emotions and dissatisfaction with the body image that affected the self-evaluative area, along together to a short future projection. The social self-care was favoured by a family support network and activities in the spare time. Conclusions: The physical and social dimensions of self-care are the most cared by women; on the other hand, the psychological dimension is of greater vulnerability(AU)