Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication. General management and specific interventions for drugs of abuse.

OBJECTIVE: To present the Brazilian Psychiatric Association's Consensus for the Management of Acute Intoxication. METHODS: A group of experts selected by the Brazilian Psychiatric Association searched for articles in the MEDLINE (by PubMed) and Cochrane Database, limited to human studies and acute intoxication. Groups reviewed these materials for appropriateness to the topic and the quality of the work. To perform a table of agreed recommendations at the end of the systematic review, a survey using the Delphi method was conducted. Three survey rounds were conducted to develop a consensus. RESULTS: Support for intoxication may start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For that, the group proposed these orders of assessment: A (airway), B (breathing), C (circulation), D.1. (disability), D.2. (differential diagnosis), D.3. (decontamination), D.4. (drug antidotes), E (enhanced elimination). Then, the group of experts presented specific interventions for the main drugs of abuse. CONCLUSIONS: The approach to intoxication with drugs of abuse is complex and requires systematic protocols. The group of experts suggested the adoption of the classic use in welcoming the patient of the A-B-C-D-E technique with constant investigation of this patient until reaching a specific conduct and with the support to remit the picture. The group of experts believes that this document, at this time, can help psychiatric, general, and emergency doctors deal with psychiatric emergency episodes due to acute intoxication.

Primary HPV-DNA screening in women under 30 years of age: health technology assessment / Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria

Background: Primary screening with Human Papilloma Virus (HPV) testing was introduced in Colombia in 2014 for individuals between 30 and 65 years of age. When the result is positive, cytology triage is performed for colposcopy referral. The convenience of initiating HPV-DNA testing for screening at 25 years of age is currently a subject of discussion. Therefore, the objective of this health technology assessment (HTA) is to analyze the available evidence regarding safety, efficacy, cost-effectiveness, values and preferences, ethical dilemmas and considerations pertaining to the implementation of the HPV-DNA test as a cervical screening strategy in women under 30 years of age in the Colombian context. Domains to be assessed: Clinical efficacy and safety 1. Cumulative rate of cervical intraepithelial neoplasia (CIN) grade 2 or high-er after 2 screening rounds. 2. Cumulative rates of invasive cancer of the uterine cervix after 2 screening rounds. 3. Safety: referral to colposcopy. Cost-effectiveness Cost-effectiveness for Colombia. Other domains considered Ethical considerations associated with cervical screening in women under 30 years of age. Organizational and individual considerations. Barriers and facilitators pertaining to the implementation of cervical screening in women under 30 years of age in the Colombian context. Methods: Clinical efficacy and safety assessment A systematic literature search of systematic reviews and clinical trials was conducted in MEDLINE, Embase and CENTRAL. The body of evidence was rated using the GRADE approach. An interdisciplinary team was then convened to create a working group to review the retrieved evidence. This led to the discussion and construction of the conclusions following the guidelines of a formal consensus in accordance with the RAND/UCLA methodology. Economic study Systematic literature research of studies that had assessed cost-effectiveness for Colombia. Results: Clinical outcomes An integrative analysis of 5 randomized clinical trials that met the inclusion critera was performed. Compared with cytology, primary HPV-DNA testing in women under 30 years of age could be associated with a lower frequency of CIN+2 lesions during the first screening round (RR: 1.57; CI: 1.20 to 2.04; low evidence certainty), and a lower incidence of CIN+2 (RR: 0.67; CI: 0.48 to 0.92; low evidence certainty). Moreover, it is associated with a lower frequency of invasive carcinoma at the end of follow-up (RR: 0.19; CI: 0.07 to 0.53; high evidence certainty). Economic results From the financial point of view, the use of HPVDNA testing plus cytology-based triage starting at 25 years of age is perhaps the most cost-effective option for Colombia (incremental cost-effectiveness ratio, COP 8,820,980 in 2013). Other implications Two studies suggest that barriers to implementation attributable to intermediation, public unrest and geographic considerations could be overcome with the use of new screening technologies or strategies. It is important to consider administration and service provision alternatives in order to overcome some acceptability and access barriers. Any cervical screening program must take into consideration ethical principles of nonmaleficence, beneficence, autonomy and equity. Future studies should focus on analyzing new screening techniques with emphasis on the population under 30 years of age. Conclusions: The use of HPV-DNA testing as a screening strategy in women under 30 years of age is a potentially efficacious and cost-effective intervention for Colombia. Future studies should focus on analyzing new screening technologies, with emphasis on the population under 30 years of age.

Antecedentes: A partir del 2014 en Colombia se incorporó la Tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costoefectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años. Dominios a evaluar: Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización. 2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización. 3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años. Métodos: Evaluación de efectividad y seguridad clínicas Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia. Resultados: De 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los criterios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1.57; IC: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR:0,67; IC: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años. Conclusiones: El uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costoefectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Centro de cidadania LGBT: memórias e experiências no campo das práticas psi em prol da defesa dos direitos humanos / LGBT citizenship center: memories and experiences in the field of psi practices for the defense of human rights / Centro de ciudadanía LGBT: memorias y experiencias en el campo de las prácticas psi en defensa de los derechos humanos

O presente artigo constitui-se num relato de experiências de profissionais da Psicologia vivenciadas nos Centros de Cidadania LGBT do Programa Rio sem Homofobia, no período em que este programa e seus Centros de Cidadania estiveram plenamente ativos e presentes em diferentes pontos do estado do Rio de Janeiro. Este programa é vinculado à Superintendência de Direitos Individuais, Coletivos e Difusos da então Secretaria de Assistência Social e Direitos Humanos do estado do Rio de Janeiro (SUPERDir/SEASDH) e tem como objetivos gerais o combate às homo, lesbo, bi e transfobias, bem como a promoção da cidadania LGBT. A partir de alguns casos por nós acompanhados, discutimos possibilidades de intervenção que se colocassem ao lado do movimento de ampliação da potência de vida dos(as) usuários(as) do serviço, principalmente pela proposta de intervenções interdisciplinares e articuladas com o contexto da demanda e/ou violação. Desta forma, reiteramos a importância de construirmos o campo das práticas psi atravessado por um trabalho em rede pautado por questões relacionadas aos Direitos Humanos, movimento social e políticas públicas...(AU)

This article is a narrative of the experiences of psychology professionals working in the LGBT Citizenship Centers of the Rio without Homophobia Programme, in the period in which this program and its Citizenship Centers were fully active and present in different parts of the state of Rio de Janeiro. This program is linked to the Superintendence of Individual, Collective and Diffuse Rights of the Department of Social Assistance and Human Rights of the state of Rio de Janeiro (SUPERDir/SEASDH) and has as general objectives the combat against homo, lesbo, bi and transphobia, as well as the promotion of LGBT citizenship. From a few cases we monitored, we discussed possibilities for intervention that were placed alongside the movement to increase the potency of life of the users of the service, mainly by the proposal of interdisciplinary interventions and articulations with the context of demand and/or violation. In this way, we reiterate the importance of constructing the field of psi practices through a networked work based on issues related to Human Rights, social movement and public policies...(AU)

Este artículo es un informe de las experiencias de los profesionales de psicología que vivieron en los Centros de Ciudadanía LGBT de Río sin el Programa de Homofobia, durante el período en que este programa y sus Centros de Ciudadanía estuvieron completamente activos y presentes en diferentes partes del estado de Río de Janeiro. Este programa está vinculado a la Superintendencia de Individuos, Colectivos y Difusos de la entonces Secretaría de Asistencia Social y Derechos Humanos del estado de Río de Janeiro (SUPERDir/SEASDH) y tiene como objetivos generales la lucha contra el homo, lesbo, bi y transfobías, así como la promoción de la ciudadanía LGBT. Con base en algunos casos que hemos seguido, discutimos las posibilidades de intervención que se colocarían junto con el movimiento para aumentar el poder de servicio de los usuarios del servicio, principalmente debido a la propuesta de intervenciones interdisciplinarias y articuladas con el contexto de demanda y / o violación Por lo tanto, reiteramos la importancia de construir el campo de las prácticas psi atravesadas por una red basada en temas relacionados con los Derechos Humanos, el movimiento social y las políticas públicas...(AU)

Ecological meta-analysis of bloom-forming planktonic Cyanobacteria in Argentina.

The aim of the present research was to summarize the main reasons that explain the distribution of harmful blooms of cyanobacteria in Argentina. It is a large territory with climates ranging from humid tropical to cold temperate. We performed a meta-analysis of the published data and information in technical reports published from 1945 to 2015, and included additional data from personal non-published studies. A total of 122 water bodies affected by planktonic cyanobacterial blooms were recorded and geo-referenced. The analysis showed that blooms, defined as events exceeding 5000 cells/mL, occurred in different types of water bodies, including shallow lakes, rivers, streams, reservoirs, estuaries and storage facilities. Maximum bloom abundance and species and ecological strategies (dispersive, scum-forming, nitrogen fixer) responsible for each event were related to the geographic and climatologic characteristics and type and origin of water bodies. The Puna and the Andean Patagonia eco-regions were mostly free of blooms. The most impaired aquatic systems were shallow lakes and reservoirs (46.7 and 24.6%, respectively). Deep lakes had no reports of blooms and rivers were mainly affected at the regulated reaches, with intensities generally decreasing downstream the dams. Besides, 74.3% of the blooms reported in Argentina exceeded WHO Alert Level 2 for drinking and bathing waters (100,000 cells/mL). Thirty-nine species, identified by Komárek's polyphasic approach to taxonomy, were responsible for the blooms. Microcystis aeruginosa, Dolichospermum spiroides, Dolichospermum circinale, Raphidiopsis mediterranea and Cylindrospermopsis raciborskii were frequently found participating in either mixed or single species blooms. The species distribution was associated with the eco-region and aquatic system typologies and affected by seasonality and climatological and geographic variables. The eco-strategies of cyanobacterial species showed stronger associations with the qualitative and quantitative indicators used in the meta-analysis, and appeared as useful tools for management measures.

Centro de cidadania LGBT: memórias e experiências no campo das práticas psi em prol da defesa dos direitos humanos / LGBT citizenship center: memories and experiences in the field of psi practices for the defense of human rights / Centro de ciudadanía LGBT: memorias y experiencias en el campo de las prácticas psi en defensa de los derechos humanos

O presente artigo constitui-se num relato de experiências de profissionais da Psicologia vivenciadas nos Centros de Cidadania LGBT do Programa Rio sem Homofobia, no período em que este programa e seus Centros de Cidadania estiveram plenamente ativos e presentes em diferentes pontos do estado do Rio de Janeiro. Este programa é vinculado à Superintendência de Direitos Individuais, Coletivos e Difusos da então Secretaria de Assistência Social e Direitos Humanos do estado do Rio de Janeiro (SUPERDir/SEASDH) e tem como objetivos gerais o combate às homo, lesbo, bi e transfobias, bem como a promoção da cidadania LGBT. A partir de alguns casos por nós acompanhados, discutimos possibilidades de intervenção que se colocassem ao lado do movimento de ampliação da potência de vida dos(as) usuários(as) do serviço, principalmente pela proposta de intervenções interdisciplinares e articuladas com o contexto da demanda e/ou violação. Desta forma, reiteramos a importância de construirmos o campo das práticas psi atravessado por um trabalho em rede pautado por questões relacionadas aos Direitos Humanos, movimento social e políticas públicas.(AU)

This article is a narrative of the experiences of psychology professionals working in the LGBT Citizenship Centers of the Rio without Homophobia Programme, in the period in which this program and its Citizenship Centers were fully active and present in different parts of the state of Rio de Janeiro. This program is linked to the Superintendence of Individual, Collective and Diffuse Rights of the Department of Social Assistance and Human Rights of the state of Rio de Janeiro (SUPERDir/SEASDH) and has as general objectives the combat against homo, lesbo, bi and transphobia, as well as the promotion of LGBT citizenship. From a few cases we monitored, we discussed possibilities for intervention that were placed alongside the movement to increase the potency of life of the users of the service, mainly by the proposal of interdisciplinary interventions and articulations with the context of demand and/or violation. In this way, we reiterate the importance of constructing the field of psi practices through a networked work based on issues related to Human Rights, social movement and public policies.(AU)

Este artículo es un informe de las experiencias de los profesionales de psicología que vivieron en los Centros de Ciudadanía LGBT de Río sin el Programa de Homofobia, durante el período en que este programa y sus Centros de Ciudadanía estuvieron completamente activos y presentes en diferentes partes del estado de Río de Janeiro. Este programa está vinculado a la Superintendencia de Individuos, Colectivos y Difusos de la entonces Secretaría de Asistencia Social y Derechos Humanos del estado de Río de Janeiro (SUPERDir/SEASDH) y tiene como objetivos generales la lucha contra el homo, lesbo, bi y transfobías, así como la promoción de la ciudadanía LGBT. Con base en algunos casos que hemos seguido, discutimos las posibilidades de intervención que se colocarían junto con el movimiento para aumentar el poder de servicio de los usuarios del servicio, principalmente debido a la propuesta de intervenciones interdisciplinarias y articuladas con el contexto de demanda y / o violación Por lo tanto, reiteramos la importancia de construir el campo de las prácticas psi atravesadas por una red basada en temas relacionados con los Derechos Humanos, el movimiento social y las políticas públicas.(AU)

Biting myself so I don't bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths

Objective: To characterize non-suicidal self-injury (NSSI) behaviors, methods, and functions as well as suicide ideation in the adolescent population of a Portuguese community in São Miguel Island, Azores. Increasing rates of NSSI behaviors among adolescents have been observed globally, while suicidal behavior has been pointed as a major cause of death during adolescence. Methods: A sample of 1,763 adolescents, aged 14 to 22, was randomly drawn from public and private schools and administered a set of self-report questionnaires. Descriptive and regression analyses were used to look for specific relationships and predictors of NSSI and suicide ideation in this isolated community. Results: Approximately 30% of youths reported at least one NSSI behavior, a rate that is twice as high as most studies carried out in mainland Portugal and in other European countries. Biting oneself was the most frequent form of NSSI, and NSSI behaviors served predominantly automatic reinforcement purposes (i.e., regulation of disruptive emotional states). NSSI and suicide ideation encompassed different distal and proximal risk factors. Conclusions: Exploring and characterizing these phenomena is necessary to provide a better understanding, enhance current conceptualizations, and guide the development of more effective prevention and intervention strategies in youths.

Biting myself so I don't bite the dust: prevalence and predictors of deliberate self-harm and suicide ideation in Azorean youths.

OBJECTIVE:: To characterize non-suicidal self-injury (NSSI) behaviors, methods, and functions as well as suicide ideation in the adolescent population of a Portuguese community in São Miguel Island, Azores. Increasing rates of NSSI behaviors among adolescents have been observed globally, while suicidal behavior has been pointed as a major cause of death during adolescence. METHODS:: A sample of 1,763 adolescents, aged 14 to 22, was randomly drawn from public and private schools and administered a set of self-report questionnaires. Descriptive and regression analyses were used to look for specific relationships and predictors of NSSI and suicide ideation in this isolated community. RESULTS:: Approximately 30% of youths reported at least one NSSI behavior, a rate that is twice as high as most studies carried out in mainland Portugal and in other European countries. Biting oneself was the most frequent form of NSSI, and NSSI behaviors served predominantly automatic reinforcement purposes (i.e., regulation of disruptive emotional states). NSSI and suicide ideation encompassed different distal and proximal risk factors. CONCLUSIONS:: Exploring and characterizing these phenomena is necessary to provide a better understanding, enhance current conceptualizations, and guide the development of more effective prevention and intervention strategies in youths.

A reunião de equipe enquanto dispositivo reflexivo: o caso de uma equipe de saúde da família em Manguinhos - Rio de Janeiro / The team meeting as a reflective device: the case of a team of family health Manguinhos - Rio de Janeiro

A Saúde da Família tem a equipe profissional enquanto ponto estruturamente para o seu trabalho e o seu cuidado é compartilhado na relação entre os profissionsi e o usuário. A reunião de equipe constitui-se em uma importante ferramenta no cotidiano do trabalho, podendo tornar-se um espaço potente para a reflexão das práticas co cotidiano, organização do processo de trabalho e planejamento das ações. O estudo se propôs compreender a reunião de equipe en quanto dispositivo de reflexão para os processos de planejamento de uma equipe de saúde da família localizada no complexo de Manguinhos, município do Rio de Janeiro. Para o desenvolvimento do estudo utilizou-se fontes primárias e secundárias de informações. Para a pesquisa documental foram utilizados os registros da ata de reunião de equipe e os diários reflexivos das residentes de Vila União. Como fonte primária de dados utilizou-se os relatos dos profissionais coletados através de entrevistas individuais e de grupo focal. E também pesquisa bibliográfica. A reunião se conformou em um espaço mais democrático onde a gestão se efetivou de maneira compartilhada permitindo aos profissionais serem autores de uma obra, o que possibilitou, muitas vezes, sentido a uma lógica comum fazendo sentirem-se pertencentes a uma grupalidade...

A concepção de criança e a lei de nove anos / The conception of child and the nine years’law

A análise histórica da concepção de criança é indispensável para se compreender os discursos, as políticas públicas e as ações que lhe são destinadas. As transformações socioeconômicas decorrentes do século XX e a consequente necessidade do trabalho feminino produziram reestruturações, tanto no âmbito familiar, como no âmbito do cuidado e atenção voltados à infância. O presente artigo, sob o enfoque da abordagem Histórico-Cultural, visa a fazer uma reflexão acerca da concepção de criança no contexto educacional, principalmente diante das recentes políticas públicas que privilegiam a antecipação da escolaridade, nas redes estaduais de ensino. Além disso, pretende apontar algumas consequências e eventuais problemas que podem surgir com a sua implantação, e discutir as suas implicações para a organização da prática pedagógica do professor e às relações entre desenvolvimento e aprendizagem. (AU)

The historical analysis of the conception of child is essential to understand the speeches, public policies and actions that are set aside for them. The 20th century ´ social-economic changes and the consequent need for women's work produced a restructuring not only in the family, but also in the care and attention focused on childhood. The present article under the perspective of Cultural-historical approach aims to make a reflection about the conception of child in the educational context, especially in the face of recent public policies that favor education´s advance in state schools. Besides, they also intend to point out some consequences and possible problems that may arise with their implementation and discuss the implications for the teacher´s organization of methodological practice and the relationship between development and learning. (AU)