Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review.

Background: Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives: The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources: A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods: Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5-18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student-staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results: Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff-student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations: The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions: Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration: This study is registered as PROSPERO CRD42019154334. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.

Whole-school health interventions aim to modify how schools are run, to promote students' health. Some aim to promote student commitment to school to prevent the important interlinked outcomes of substance (tobacco, alcohol, other drugs) use and violence. We searched for all evaluations of such interventions. We summarised what this research said about the sorts of interventions used, how they are meant to work, what factors affect delivery, whether or not they reduce violence and substance use and whether or not they are worth the money. We found 63 reports on 27 studies of 22 interventions. We identified four subtypes of interventions. These aimed to involve students in school decisions, improve staff­student relationships, increase engagement in learning or involve parents. Most of these interventions were intended to work by making sure schools focused on student needs, or by improving relationships between staff and students, between different areas of learning or between schools and communities. This aimed to make students feel committed to school and therefore avoid violence or substance use. A few aimed to work mostly by teaching students how to avoid violence and substance use. We found that interventions were well implemented if they were tailored for each school and had good materials and support. Interventions were well delivered if they were led by action groups (comprising staff, students, etc.) or provided schools with information on students' needs. Implementation was affected by whether or not schools accepted the need for change and whether or not staff had the necessary time and money to do the work. These interventions appear to have small, but significant, intervention impacts in preventing violence and substance use among young people. There was not consistent evidence of different effects for different students. A small number of studies suggest that such interventions might show economic benefit, but this would need further research. Future research should focus on interventions that are refined to make sure that they can be well delivered.

[Bullying victimization and associated factors among schoolchildren in a city in the south of Brazil]. / Vitimização por bullying e fatores associados entre escolares de um município do Sul do Brasil.

The objective was to assess the prevalence of bullying victimization and associated factors among adolescents in the city of Pelotas, Rio Grande do Sul. A cross-sectional school-based study was conducted with 795 ninth grade students from 25 urban municipal schools linked to the School Health Program. Bullying was assessed using questions that addressed the occurrence, frequency, location, type of violence suffered and how much it bothers the victims. Gross and adjusted analyses were performed by Poisson regression. Approximately 71% of the students reported having suffered bullying, and school was the location of greatest occurrence (86.7%). Among the types of aggression suffered, "nicknames" was the most recurrent complaint (88.4%), followed by exclusion or isolation (26.6%). Victimization was more frequent among girls (PR 1.13; 95%CI 1.02-1.27), students with non-white skin color/race (PR 1.16; 95%CI 1.05-1.29), who have already tried tobacco (PR 1.14; 95%CI 1.03-1.27), dissatisfied (PR 1.42; 95%CI 1.27-1.58) or indifferent (PR 1.21; 95%CI 1.02-1.43) about their bodies, and who were overweight (PR 1.15; 95%CI 1.04-1.27). The results show that bullying is a frequent practice in the school environment, pointing to the need for educational practices aimed at reducing and preventing this type of violence.

O objetivo foi avaliar a prevalência de vitimização por bullying e seus fatores associados entre adolescentes da cidade de Pelotas, RS. Estudo transversal de base escolar realizado com 795 alunos do 9o ano do ensino fundamental de 25 escolas municipais urbanas vinculadas ao PSE. O bullying foi avaliado por meio de perguntas que abordaram a ocorrência, a frequência, o local, o tipo de violência sofrida e o quanto isso incomoda as vítimas. Análises bruta e ajustada foram feitas por regressão de Poisson. Aproximadamente 71% dos estudantes relataram ter sofrido bullying, a escola foi o local de maior ocorrência (86,7%). Entre os tipos de agressões sofridas, "apelidos" foi a queixa mais recorrente (88,4%), seguida por exclusão ou isolamento (26,6%). A vitimização foi mais frequente entre as meninas (RP 1,13; IC95% 1,02-1,27), estudantes com cor da pele/raça não branca (RP 1,16; IC95% 1,05-1,29), que já experimentaram tabaco (RP 1,14; IC95% 1,03-1,27), insatisfeitos (RP 1,42; IC95% 1,27-1,58) ou indiferentes (RP 1,21; IC95% 1,02-1,43) em relação ao corpo e que apresentavam excesso de peso (RP 1,15; IC95% 1,04-1,27). Os resultados mostram que o bullying é uma prática frequente no ambiente escolar, apontando para a necessidade de práticas educativas voltadas para a redução e prevenção desse tipo de violência.

Prosocial behaviours and emotional intelligence as factors associated with healthy lifestyles and violence in adolescents.

Adolescence is a stage of life characterised by vulnerability, which shapes young people's trajectories and potentially influences their behaviour. In this crucial period, the promotion of prosocial behaviours and the development of emotional intelligence are understood as key factors influencing adolescents' psychological and personal well-being. The general objective of this study was to find out the relationship between these two variables - prosocial behaviours and emotional intelligence - and their correlation with the maintenance of a healthy lifestyle and another fundamental aspect such as violence among young people in the academic context. A total of 743 secondary school students participated in this research with a descriptive-cross-sectional design. This study used several instruments, including an ad hoc questionnaire to assess socio-demographic aspects and school violence, the Prosocial Behaviour Questionnaire (PBQ), the TMMS-24 for the assessment of Emotional Intelligence, the Healthy Lifestyles Questionnaire (HLQ-II) and the Satisfaction with Life Scale (SLS). The results highlighted a convincing link between the display of prosocial behaviours and emotional intelligence with various dimensions of healthy living such as healthy diet or respect for mealtimes. In particular, the research revealed a pronounced correlation between adolescents who showed greater emotional repair and respect and their lower involvement in school violence and substance use. In addition, the likelihood of having a healthy life was found to be linked to variables such as being male, respect, social relationships and emotional repair. In contrast, the likelihood of having an excessive consumption of certain harmful substances such as alcohol or tobacco was found to be linked to age, empathy and emotional clarity. These results highlight the crucial role that prosocial behaviours and emotional intelligence play in shaping adolescents' lives. In conclusion, the need to promote such variables as prosocial behaviours and emotional intelligence in adolescent students in order to promote healthy lifestyles and reduce school violence and substance use in this age group is discussed.

Distress about social problems and tobacco and cannabis use outcomes among young adults in Los Angeles County.

OBJECTIVE: To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults. METHODS: A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use. RESULTS: The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use. CONCLUSIONS: Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later.

Social support in relation to posttraumatic stress disorder symptoms among patients with violent versus nonviolent injury.

OBJECTIVE: Violent injuries have become increasingly more common in the United States. Individuals experiencing violent injury are at increased risk for the development of posttraumatic stress disorder (PTSD) as compared to those experiencing nonviolent injury. Social support is touted as a protective factor against various psychiatric symptoms (i.e., PTSD), though little is known about the relation between PTSD symptoms and social support in traumatic injury populations. The aims of the present paper were twofold: (1) examine the prevalence of PTSD as a function of injury type (2) explore differences in levels of social support as a function of injury type and (3) explore the association between injury type and later PTSD symptoms as moderated by baseline social support. METHOD: Participants were 553 adults from a level-one trauma center in the Southeast United States who experienced a violent injury or nonviolent injury and completed measures of social support at baseline as well as PTSD symptoms at the 30-day follow-up timepoint. The study utilized data from both the baseline timepoint (i.e., upon admission to the trauma surgery unit), as well as a 30-day follow-up timepoint. RESULTS: Results demonstrated that those endorsing nonviolent injury reported lower levels of social support and PTSD symptoms. Social support predicted later PTSD symptoms until injury type was included as a covariate in the model. Social support did not moderate the relationship between injury type and later PTSD symptoms. CONCLUSIONS: Findings highlight the interrelatedness of key risk variables (i.e., injury type) with protective factors in influencing the trajectory of psychopathology postinjury. Violence intervention and interruption programs may have the capacity to fill patient needs when social support networks are insufficient. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. / Agressivité et violence au cours de l'exercice professionnel en ophtalmologie : analyse descriptive d'un questionnaire adressé aux internes et assistants des régions Grand Est, Bourgogne-Franche-Comté.

INTRODUCTION: The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS: We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS: The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION: We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.

Racial/Ethnic disparities in exposure to neighborhood violence and lung cancer risk in Chicago.

BACKGROUND: Despite the lower prevalence and frequency of smoking, Black adults are disproportionately affected by lung cancer. Exposure to chronic stress generates heightened immune responses, which creates a cell environment conducive to lung cancer development. Residents in poor and segregated neighborhoods are exposed to increased neighborhood violence, and chronic exposure to violence may have downstream physiological stress responses, which may explain racial disparities in lung cancer in predominantly Black urban communities. METHODS: We utilized retrospective electronic medical records of patients who underwent a screening or diagnostic test for lung cancer at an academic medical center in Chicago to examine the associations between lung cancer diagnosis and individual characteristics (age, gender, race/ethnicity, and smoking status) and neighborhood-level homicide rate. We then used a synthetic population to estimate the neighborhood-level lung cancer risk to understand spatial clusters of increased homicide rates and lung cancer risk. RESULTS: Older age and former/current smoking status were associated with increased odds of lung cancer diagnosis. Hispanic patients were more likely than White patients to be diagnosed with lung cancer, but there was no statistical difference between Black and White patients in lung cancer diagnosis. The odds of being diagnosed with lung cancer were significantly higher for patients living in areas with the third and fourth quartiles of homicide rates compared to the second quartile of homicide rates. Furthermore, significant spatial clusters of increased lung cancer risk and homicide rates were observed on Chicago's South and West sides. CONCLUSIONS: Neighborhood violence was associated with an increased risk of lung cancer. Black residents in Chicago are disproportionately exposed to neighborhood violence, which may partially explain the existing racial disparity in lung cancer. Incorporating neighborhood violence exposure into lung cancer risk models may help identify high-risk individuals who could benefit from lung cancer screening.

Pediatric Surgery Firearm Injury Collaborative Symposium.

Injury from a firearm is now the leading cause of death of children and youth under age 19 in the United States (U.S.) [1] and the incidence of these deaths continues to increase each year [2]. For every death from firearm violence, there are several young people who have been injured by a bullet but not killed. As pediatric surgeons, we are on the front lines of treating these young patients. We have the unforgettable memories of delivering the horrible news to parents in "quiet rooms." [3]. As these injuries fall within our scope of practice, it is incumbent on us as professionals to work to prevent these injuries, apply best practices and work for the best pathways to recovery for our patients who do survive. There is a diverse community of pediatric surgeons tackling this public health problem in a variety of ways [4]. In a pre-meeting symposium at the APSA 2023 Annual meeting, we brought together a community of pediatric surgeons working on this critical area. The following summarizes the presentations of the symposium, with topics including Risk Factors, Injury Prevention, Treatment, Public Initiatives, and National Collaborative Efforts. TYPE OF STUDY: Review Article, Proceedings of a Symposium. LEVEL OF EVIDENCE: 1 through 4 all presented.

Dentistry Students' Knowledge of Pediatric Patients Who Suffered Violence: A Systematic Review

ABSTRACT Objective: To review the literature unprecedentedly to identify the dentistry students' knowledge of pediatric patients who suffered violence. Material and Methods: A systematic review was conducted using PubMed, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey electronic databases up to November 2021. The "Grey Literature" was verified through Google Scholar and Open Grey searches to avoid any selection bias. There was no restriction on the date of publication or language. Results: The systematic search yielded 2.756 studies in the first selection phase, but only twenty-two articles were included. All selected articles were published between 1998 and 2021 and used a questionnaire to evaluate the dentistry students' knowledge regarding child maltreatment cases. Brazil was the country that had the most studies included (10 articles). Despite the majority of the students presenting insufficient knowledge about child maltreatment, evidence from this research showed that every form of approach by professionals toward child maltreatment should be considered important. Conclusion: Therefore, there are deficiencies regarding the teaching-learning methodology, reinforcing the need for improvements in Dentistry undergraduate curricula.

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults.

Importance: Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain. Objective: To estimate the economic burden of ACE-associated health conditions among US adults. Design, Setting, and Participants: In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022. Exposure: Adverse childhood experiences (age <18 years). Main Outcomes and Measures: Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels. Results: A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million. Conclusions and Relevance: In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

Jornalismo, população em situação de rua e eventos internacionais: uma análise de reportagens do jornal O Globo em 2017 / Journalism, homeless population and international events: an analysis of reportages in O Globo newspaper in 2017 / Periodismo, población en situación de calle y eventos internacionales: un análisis de reportajes del periódico O Globo en 2017

Este artigo tem o propósito de analisar as representações das pessoas em situação de rua e da violência em quatro reportagens expressivas do jornal O Globo, a fim de identificar se elas são retratadas como responsáveis pela violência urbana ou como vítimas de grupos violentos. Serão examinadas reportagens publicadas em 2017, um ano após a cidade ter passado por transformações significativas para os Jogos Olímpicos e Paralímpicos, incluindo investimentos em segurança pública por parte dos governos federal e estadual, alterações no espaço urbano e remoção forçada de pessoas em situação de rua das áreas turísticas. Para atingir o objetivo proposto, será utilizada como metodologia a análise de narrativas conforme Bastos e Biar e Spink. Em resumo, o jornal oscilou entre a demonização dessas pessoas, reforçando preconceitos associados a elas, e a abertura, ainda que em menor medida, para a divulgação das violências enfrentadas por esse segmento da população

This article aims to analyze the representations of people experiencing homelessness and of violence in four significant reportages in O Globo newspaper in order to determine whether they are portrayed as responsible for urban violence or as victims of violent groups. The selected reportages which will be examined were published in 2017, a year after the implementation of significant transformations in the city for the Olympic and Paralympic Games, including investments in public security by the federal and state governments, changes in urban space, and removal of homeless population by force from tourist areas. To achieve the proposed objective, the narrative analysis according to the approaches of Bastos and Biar and Spink will be employed as methodology. In short, the newspaper oscillated between demonising these individuals, reinforcing prejudices associated with them, and opening up, albeit to a lesser extent, to publicise the violence faced by this segment of the population

Este artículo tiene como objetivo analizar las representaciones de las personas en situación de calle y de la violencia en cuatro reportajes significativos del periódico O Globo para determinar si él las retrata como responsables de la violencia urbana o como víctimas de grupos violentos. Serán examinados reportajes publicados en 2017, un año después de que la ciudad había pasado por transformaciones significativas debido a los Juegos Olímpicos y Paralímpicos, que incluyeron inversiones en seguridad pública por parte de los gobiernos federal y estatal, cambios en el espacio urbano y la remoción forzada de personas en situación de calle de las zonas turísticas. Para lograr el objetivo propuesto, se empleará el análisis narrativo como metodología de acuerdo con los enfoques de Bastos y Biar y Spink. En resumen, el periódico osciló entre la demonización de estas personas, reforzando los prejuicios asociados a ellas, y la apertura, aunque en menor medida, a la divulgación de las violencias enfrentadas por este segmento de la población

Relatos de madres de desaparecidos: voces desde el colectivo / Stories of mothers of the disappeared: voices from the collective

La desaparición forzada en el país es alarmante, sobre todo de jóvenes de 15 a 29 años. Este evento rompe el lazo social y deja a las madres en estado traumático. El propósito de esta investigación fue triangularlas narrativas de desaparición, denuncia e integración de las madres al colectivo. Los resultados muestran que la vivencia de desaparición y el proceso de denuncia son tramas de degradación, donde las madres quedan revictimizadas, dado el maltrato de servidores públicos; mientras que, la integración a un colectivo hace de ideal reparatorio, pues confraternizan las madres en su dolor y resistencia en la búsqueda. Se concluye invitando a los psicólogos a buscar modos de elaboración acordes a la vivencia de trauma social AU

The enforced disappearance in this country is alarming, especially for young people between 15 and 29 years old. This event breaks the social bond and leaves mothers in a traumatic state. The purpose of this research is to triangulate the narratives of disappearance, filling in reportsand integration of the mothers into the collective. The results show that the experience of disappearance and the reporting processesare degrading,where the mothers are re-victimized, given the mistreatment of public servants. Beingthe integration to a collective a reparatory ideal, because the mothers fraternize in their pain and resistance in the searching. It concludes by inviting psychologists to seek ways of elaboration according to the experience of social trauma AU

La influencia del consumo de pornografía en la construcción de la sexualidad masculina de jóvenes chilenos / The influence of pornography consumption on the construction of male sexuality in young chilean men

Este trabajo está orientado a conocerla influencia que ejerce la pornografía en la construcción de la sexualidad de hombres jóvenes consumidores de la ciudad de Temuco, Chile. De acuerdo con la literatura la pornografía es vista de forma mayoritaria por jóvenes varones que van desde los 12 años hasta su adultez. Esta situación influye en la socialización de los varones y en su concepción de la sexualidad que resulta ser problemática como consecuencia de este consumo. Para esto se realizó una investigación de carácter cualitativo en la cual se aplicaron diez entrevistas semiestructuradas a jóvenes consumidores de 21 a 26 años y a dos expertos (en educación y en sexualidad). Los resultados apuntan a la existencia una fuerte influencia de la pornografía en la sexualidad de los jóvenes. No limitada sólo a la sexualidad, sino que además a la concepción propia de la masculinidad y su rol en las relaciones afectivos-sexuales. Finalmente, los resultados evidencian que los jóvenes reflexionan sobre los elementos negativos que han debido afrontar dadas las sustanciales diferencias que tiene la ficción con la realidad en el consumo de pornografía AU

This work is oriented to know the influence that pornography exerts in the constructionof the sexuality of young male consumers in the city of Temuco, Chile. According to the literature, pornography is viewed mostly by young men ranging from 12 years to adulthood. This situation influences the socialization of men and their conception of sexuality, which turns out to be problematic as a consequence of this consumption. For this, a qualitative investigation was carried out in which ten semi-structured interviews were applied to young consumers between the ages of 21 and 26 and to two experts (in education and in sexuality). The results point to the existence of a strong influence of pornography on the sexuality of young people. Not limited only to sexuality, but also to the own conception of masculinity and its role in affective-sexual relationships. Finally, the results show that young people reflect on the negative elements that they have had to face given the substantial differences between fiction and reality in the consumption of pornography AU

Intersubjetividad y Violencia en la Adolescencia: Análisis de relatos con el Algoritmo David Liberman. Parte I Deseos / Inter-Subjectivity and Violence in Adolescence: Analysis of Narratives Using the David Liberman Algorithm. Part I: Desires

El objetivo de este artículo es analizar, desde una perspectiva intersubjetiva, los deseos predominantes en los relatos de un adolescente violento y su madre en una sesión vincular. El Algoritmo David Liberman-ADL es el método utilizado, focalizando en un aporte novedoso transmitido por Maldavsky que permite una diferenciación entre los relatos centrados en terceros y los relatos centrados en el propio narrador. En relación con la intersubjetividad, el análisis de los deseos en una sesión vincular permitió detectar que en el vínculo que han podido establecer el adolescente y su madre a lo largo de su vida predominan situaciones de carencia y de vulnerabilidad psicosocial que se manifiesta en un conflicto patógeno en relación con la endogamia-exogamia ante la imposibilidad del logro psíquico del desasimiento de la autoridad parental. El adolescente realiza una salida fallida de su casa a través de conductas agresivas hacia sus pares en un contexto de riesgo, lo cual retroalimenta el temor materno e intensifica el control hacia su hijo. Si bien se observa que la madre intenta ejercer un rol adecuado, aún no puede preguntarse por el deseo de su hijo que se manifiesta en esa actitud oscilante entre abúlica y agresiva AU

The objective of this article is to analyze, from an intersubjective perspective, the predominant desires within the narratives of a violent teenager and his mother during a therapeutic session. The David Liberman Algorithm (ADL) is the method employed, focusing on a novel contribution introduced by Maldavsky that enables differentiation between narratives centered on third parties and those centered on the narrator themself. In the context of intersubjectivity, the analysisof desires within this therapeutic session reveals that the relationship between the adolescent and his mother has been marked by situations of deficiency and psychosocial vulnerability throughout their lives. This is manifested in a pathogenic conflict related to endogamy-exogamy concerning the unattainable psychological detachment from parental authority. The adolescent attempts an unsuccessful departure from his home through aggressive behavior towards peers in a high-risk environment, which, in turn, exacerbates his mother's fears and intensifies her control over her son. Although it is evident that the mother is trying to assume an appropriate role, she is still unable to explore her son's desires, as demonstrated by his oscillation between apathy andaggression AU

A Colonização da Adolescência e sua Subversão pela Psicanálise / The Colonization of Adolescence and its Subversion by Psychoanalysis / La Colonización de la Adolescencia y su Subversión por el Psicoanálisis

O presente artigo possui o objetivo de, a partir de uma investigação teórica de textos sociais e psicanalíticos, analisar como a adolescência aparece, na modernidade, como um privilegiado produto político da colonização. Associamos à emergência dessa idade da vida, a biopolítica e a necropolítica, sendo a primeira um conceito de Michel Foucault e a segunda, de Achille Mbembe. Igualmente, analisamos como que o significante "adolescência" é interceptado por diferentes significados violentos, os quais deslocam-se inversamente e abaixo da cadeia de significantes, e que aprisionam os adolescentes em sentidos colonizadores, impondo-lhes um processo de destituição subjetiva. Recorremos às contribuições de Glória Anzaldúa e do psicanalista Jacques Lacan, para indicar uma outra identidade adolescente possível a qual prima pela proposição de novos significados e pelo deslocamento metonímico do significante, opondo-se àquela forjada pela colonização. Assim, indicamos como que a Psicanálise pode ser uma opção viável para a subversão da colonização da adolescência, privilegiando o sujeito e o desejo.

This article aims, from a theoretical investigation of social and psychoanalytical texts, to analyze how adolescence appears, in modernity, as a privileged political product of colonization. We associate biopolitics and necropolitics to the emergence of that age of life, the first being a concept by Michel Foucault and the second by Achille Mbembe. Likewise, we analyze how the signifier "adolescence" is intercepted by different violent signifieds, which move inversely and down the chain of signifiers, and which imprison adolescents in colonizing senses, imposing a process of subjective destitution on them. We resorted to the contributions of Glória Anzaldúa and the psychoanalyst Jacques Lacan, to indicate another possible adolescent identity which excels in proposing new signifieds and in the metonymic displacement of the signifier, opposing the identities forged by colonization. Thus, we indicate how Psychoanalysis can be a viable option for the subversion of the colonization of adolescence, privileging the subject and desire.

Este artículo tiene como objetivo, a partir de una investigación teórica de textos sociales y psicoanalíticos, analizar cómo la adolescencia aparece, en la modernidad, como un producto político privilegiado de la colonización. Asociamos la biopolítica y la necropolítica al surgimiento de esa edad de la vida, siendo la primera un concepto de Michel Foucault y la segunda de Achille Mbembe. Asimismo, analizamos cómo el significante "adolescencia" es interceptado por diferentes significados violentos, que se mueven en sentido inverso y descendente en la cadena de los significantes, y que aprisionan a los adolescentes en sentidos colonizadores, imponiéndoles un proceso de destitución subjetiva. Recurrimos a los aportes de Glória Anzaldúa y del psicoanalista Jacques Lacan, para señalar otra posible identidad adolescente que sobresale en la propuesta de nuevos significados y en el desplazamiento metonímico del significante, contraponiéndose a las identidades forjadas por la colonización. Así, indicamos cómo el Psicoanálisis puede ser una opción viable para la subversión de la colonización de la adolescencia, privilegiando el sujeto y el deseo.

Reflexões Sobre o Corpo Estranho e a Política de Morte na Terra Indígena Yanomami / Reflections on the Foreign Body and the Politics of Death on the Yanomami Indigenous Land Yanomami / Reflexiones Sobre el Cuerpo Extraño y las Políticas de la Muerte en la Tierra Indígena Yanomami

Este artigo tem como objetivo analisar a relação entre os conceitos de necropolítica, proposto por Achille Mbembe, e de unheimlich, desenvolvido por Sigmund Freud. Por meio dessa possibilidade de intersecção, coloca-se em análise a situação enfrentada pelos Yanomami no norte do Brasil, na qual diversos indígenas tiveram suas terras invadidas e seus direitos violados, levando-os a uma grave crise sanitária. A presença de uma lógica de gestão necropolítica, na qual corpos que não interessam ao Estado são deixados à margem, coloca em risco populações que não são incluídas no discurso hegemônico neoliberal. No encontro deste discurso com o estranho, pode-se inferir que é produzida uma experiência unheimlich, um deparar-se com o que há de mais incômodo e ao mesmo tempo familiar à sociedade. Reconhecer-se na diferença que há no outro cria um escape pela via da eliminação, faz-se desse corpo o inimigo e, assim, cria-se o respaldo para tirá-lo de cena. Desse modo, esta investigação destaca a necessidade de repensarmos as vias existentes para lidar com a diferença, isto porque, construir uma sociedade em detrimento de determinados grupos que a compõem é destruir também a si mesma.

This article aims to analyze the relationship between the concepts of necropolitics, proposed by Achille Mbembe, and unheimlich, developed by Sigmund Freud. Through this possibility of intersection, the situation faced by the Yanomami in northern Brazil can be analyzed, in which several indigenous people had their lands invaded and their rights violated, leading them to a serious health crisis. The presence of a necropolitical management logic, in which bodies that are not of interest to the State are left on the sidelines, puts populations that are not included in the hegemonic neoliberal discourse at risk. In the encounter between this discourse and the stranger, it can be inferred that an unheimlich experience is produced, an encounter with what is most uncomfortable and at the same time familiar to society. Recognizing oneself in the difference that exists in the other creates an escape through elimination, this body is made the enemy and, thus, the support is created to remove it from the scene. Furthermore, this investigation highlights the need to rethink existing ways of dealing with difference, because building a society to the detriment of certain groups that compose it is also destroying itself.

Este artículo tiene como objetivo analizar la relación entre los conceptos de necropolítica, propuesto por Achille Mbembe, y unheimlich, desarrollado por Sigmund Freud. A través de esta posibilidad de cruce, es un ejemplo la situación que enfrentan los yanomami en el norte de Brasil, en la que varios indígenas vieron sus tierras invadidas y violados sus derechos, llevándolos a una grave crisis de salud. La presencia de una lógica de gestión necropolítica, en la que se dejan al margen cuerpos que no interesan al Estado, pone en riesgo a poblaciones que no están incluidas en el discurso neoliberal hegemónico. En el encuentro de este discurso con el extraño se puede inferir que se produce una experiencia unheimlich, un encuentro con lo más incómodo ya la vez familiar para la sociedad. Reconocerse en la diferencia que existe en el otro crea una evasión por eliminación, se hace de este cuerpo el enemigo y, así, se crea el soporte para sacarlo de escena. Así, esta investigación destaca la necesidad de repensar las formas existentes de enfrentar la diferencia, porque construir una sociedad en detrimento de ciertos grupos que la componen es también destruirse a sí misma.

O luto materno em situação de violência policial: contribuições psicanalíticas / Maternal grief in situations of police violence: psychoanalytic contributions / Duelo materno en situaciones de violencia policial: aportes psicoanalíticos

A polícia brasileira já foi considerada a mais letal e frequentemente alveja jovens negros marginalizados (Araújo, 2015). As mães desses indivíduos perdem seus filhos precocemente de maneira abrupta e violenta. Para muitas mães a perda de um filho constitui a maior do mundo, o que torna relevante questionar: como a perda de um filho pela violência policial repercute no enlutamento materno? Foram encontrados poucos estudos sobre o tema, apesar de sua prevalência e dos impactos negativos permanentes na vida dessas mães (Gomes, 2019). Por meio de uma revisão bibliográfica não sistemática sobre o tema do luto e das perdas violentas, e com base em depoimentos publicizados de mães que perderam seus filhos pela violência policial, focalizamos como a psicanálise tem um importante papel na escuta dessas mulheres, que podem traçar diferentes caminhos de trabalho psíquico. Como resultado, vimos que a perda de um filho possui caráter traumático e nela se destaca a natureza narcísica da relação mãe-filho, rompida abruptamente pela morte. Este estudo oferece algumas contribuições para o entendimento desse sofrimento e para a escuta dessas mulheres, que, como muitas se autodenominam, são "mães sem nome". (AU)

Brazilian police were once considered the most lethal and often target marginalized young black men (Araújo, 2015). The mothers of these individuals lose their children early in an abrupt and violent manner. To many mothers, the loss of a child is the biggest one in the world, which makes it relevant to ask: How does the loss of a child to police violence affect maternal mourning? Few studies have been found on the topic, despite its prevalence and the permanent negative impacts on the lives of these mothers (Gomes, 2019). Through a non-systematic literature review on the theme of grief and violent loss, and based on publicized testimonials of mothers who have lost their children to police violence, we focused on how psychoanalysis has an important role in listening to these women, who can trace different paths of psychic work. As a result, we concluded that the loss of a child has a traumatic issue, and the narcissistic nature of the mother-child relationship, abruptly broken by death, stands out. This study offers some contributions to the understanding of this suffering and to the listening of these women, who, as many call themselves, "mothers without a name". (AU)

La policía brasileña fue considerada la más letal y frecuentemente ataca a los jóvenes negros marginados (Araújo, 2015). Las madres de estas personas pierden a sus hijos tempranamente de forma abrupta y violenta. Para muchas madres, la pérdida de un hijo es la mayor del mundo, lo que hace pertinente preguntarse: ¿cómo la pérdida de un hijo por la violencia policial afecta al duelo materno? Se encontraron pocos estudios sobre este tema, a pesar de su prevalencia y de los impactos negativos permanentes en la vida de estas madres (Gomes, 2019). Mediante una revisión bibliográfica no sistemática sobre el tema del duelo y de las pérdidas violentas, y a partir de testimonios difundidos de madres que perdieron a sus hijos por la violencia policial, nos centramos en cómo el psicoanálisis tiene un papel importante en la escucha de estas mujeres, que pueden trazar diferentes caminos de trabajo psíquico. Como resultado, vimos que la pérdida de un hijo tiene carácter traumático y destaca la naturaleza narcisista de la relación madre-hijo, rota abruptamente por la muerte. Este estudio ofrece algunas contribuciones a la comprensión de este sufrimiento y a la escucha de estas mujeres que, como muchas se autode-nominan, son "madres sin nombre". (AU)

Correção secundária de Fratura Blow-Out: relato de caso / Secondary correction of Blow-Out Fracture: case report / Corrección secundaria de Fractura Blow-Out: reporte de caso

Objetivo: Discutir o tratamento cirúrgico secundário de uma fratura de órbita tipo Blow-Out, explorando os desafios e limitações relacionados a este padrão de fratura. Relato de Caso: Paciente sexo masculino, 50 anos, ASA I relatando histórico de agressão física e quatro cirurgias prévias em região orbitária direita. Clinicamente foram observados sinais como enoftalmo, hipoftalmo, encurtamento da pálpebra inferior, dificuldade de oclusão palpebral, entrópio, hiperemia em conjuntiva, além de presença de secreção purulenta, todos em região orbitária à direita. Diante do exposto, uma nova intervenção cirúrgica foi proposta pela Cirurgia e Traumatologia Bucomaxilofacial, na tentativa corrigir alguns problemas listados, além de encaminhamento a outras especialidades. Encontra-se em acompanhamento de um ano, com boa evolução. Conclusão: O tratamento de fraturas orbitárias é um dos mais desafiadores, especialmente quando se trata sequelas. A definição pelo melhor momento para realização destes procedimentos não é um consenso, sendo necessário uma avaliação clínica criteriosa. Apesar da utilização dos enxertos autógenos ser amplamente recomendada, os materiais aloplásticos vem se tornando a primeira escolha para tratamento das correções secundárias pelas diversas vantagens oferecidas.

Aim: To discuss the secondary surgical treatment of a Blow-Out orbit fracture, exploring the challenges and limitations related to this fracture pattern. Case report: Male patient, 50 years old, ASA I reporting a history of physical aggression and four previous surgeries in the right orbital region. Clinically, enophthalmos, hypophthalmos, shortening of the lower eyelid, difficulty in eyelid occlusion, entropion, hyperemia in the conjunctiva were observed, in addition to the presence of purulent secretion, all in the right orbit. In view of the above, a new surgical intervention was proposed by Buccomaxillofacial Surgery and Traumatology, in an attempt to correct some listed problems, in addition to referral to other specialties. He is being followed up for one year, with good progress. Conclusion: The treatment of orbital fractures is one of the most challenging, especially when dealing with sequelae. The definition of the best time to perform these procedures is not a consensus, requiring a careful clinical evaluation. Although the use of autogenous grafts is widely recommended, alloplastic materials are becoming the first choice for treating secondary corrections due to the several advantages offered.

Objetivo: Discutir el tratamiento quirúrgico secundario de una fractura orbitaria Blow-Out, explorando los desafíos y las limitaciones relacionadas con este patrón de fractura. Caso Clínico: Paciente masculino, 50 años, ASA I, que refi ere antecedentes de agresión física y cuatro cirugías previas en región orbitaria derecha. Clínicamente se observaron signos como enoftalmos, hipoftalmos, acortamiento del párpado inferior, difi cultad en la oclusión palpebral, entropión, hiperemia en la conjuntiva, además de la presencia de secreción purulenta, todos en la región orbitaria derecha. Ante lo anterior, se propuso una nueva intervención quirúrgica desde Cirugía Oral y Maxilofacial y Traumatología, en un intento de corregir algunos de los problemas enumerados, además de la derivación a otras especialidades. Está en seguimiento desde hace un año, con buena evolución. Conclusión: El tratamiento de las fracturas de órbita es uno de los más desafi antes, especialmente cuando se trata de secuelas. La defi nición del mejor momento para realizar estos procedimientos no es un consenso, lo que requiere una evaluación clínica cuidadosa. A pesar de que se recomienda ampliamente el uso de injertos autógenos, los materiales aloplásticos se han convertido en la primera opción para el tratamiento de correcciones secundarias debido a las múltiples ventajas que ofrecen.

Impact of Implementation of a New Weapons Screening at an Urban Emergency Department.

BACKGROUND: Violence in the emergency department (ED) setting is well documented in medical literature. Weapons can be used to cause significant injury or mortality, although there is a paucity of literature on weapons and weapons screening in the ED. OBJECTIVES: The purpose of this study was to assess the impact of initiating a weapons screening process on the identification and removal of weapons. METHODS: Multiple aspects of a weapons screening program were evaluated at 2 and 6 months prior to and after a weapons screening protocol was initiated at an urban ED. In the Pre-Screen periods, only patients primarily seeking care for mental health were screened prior to entry. In the Post-Screen periods, all patients and visitors were screened with walk-through magnetometers or wand metal detectors, and additional screening checks were initiated. The number of individuals screened and numbers of weapons found were measured. Descriptive statistics comparing Pre- and Post-Screen periods were performed. RESULTS: Prior to the new screening process, 511 and 1701 patients primarily seeking care for mental health were screened, with 15 and 103 weapons confiscated at 2 and 6 months, respectively. After the screening process was initiated, 13,149 and 43,321 ED patients and visitors were screened, with 194 and 567 weapons confiscated at 2 and 6 months, respectively. Persons screened increased by 25-fold at both 2 and 6 months after implementing the screening process. Weapons confiscated increased approximately 13-fold and sixfold at the respective 2- and 6-month Pre- and Post-Screen periods, respectively. CONCLUSION: Implementation of weapons screening significantly increased the number of weapons identified and confiscated prior to entry in the ED by patients and visitors.