A Compreensão da Intersubjetividade Entre um Adolescente Suicida e seus Pais Através da Combinação de Métodos na Análise do Discurso / La Comprensión dela intersubjetividadentre un adolescente suicida y sus padres mediante la combinación de métodos en el análisis del discurso / Understanding Intersubjectivity Between a Suicidal Adolescent and His Parents Through the Combination of Methods in Discourse Analysis

Trata-se de um recorte de pesquisa de doutorado em que se intencionou estudar o vínculo intersubjetivo familiar em um adolescente com histórico de tentativa de suicídio, pautando-se nos desejos e defesas. Utilizou-se a combinação de três instrumentos (ADL-AH, ADL-R e o Genograma) para a análise do discurso. Após exame individual dos dados apontados por cada instrumento, realizou-se asanálises comparativas. Inicialmente, confrontou-se os resultados do ADL-AH com o ADL-R conforme a descrição do caso. Em seguida, o Genograma propiciou o entendimento intergeracional da família estudada, confirmou aspectos já levantados e elucidou pontos dos quais o ADL não poderia ter alcançado, embora esse último tenha encontrado discrepâncias no discurso, isto é, aquilo que se pretendia disfarçar ou esconder de forma consciente ou inconsciente. A combinaçãodos três instrumentos trouxe consistência para a investigação no sentido de uma melhor compreensão da intersubjetividade do adolescente, sua família e do comportamento suicida AU

Este es un extracto de una investigación doctoral que tuvo como objetivo estudiar el vínculo familiar intersubjetivo en un adolescente con antecedentes de intento de suicidio, basado en deseos y defensas. Para el análisis del discurso se utilizó una combinación de tres instrumentos (ADL-AH, ADL-R y Genograma). Luego de examinar individualmente los datos indicados por cada instrumento, se realizaron comparaciones. Inicialmente se confrontaran los resultados del ADL-AH con el ADL-R según la descripción del caso. Luego, el Genograma proporcionó una comprensión intergeneracional de la familia estudiada, confirmó aspectos ya planteados y aclaró puntos que la ADL no podría haber logrado, aunque este último tenga encontrado discrepancias en el discurso, es decir, lo que se pretendía disfrazar u ocultar consciente o inconscientemente. Esta combinación aportó consistencia a la investigación y con ella fue posible tener una mejor comprensión de la intersubjetividad, del adolescente, su familia y la conducta suicida AU

Primary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases.

OBJECTIVES: to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases. METHODS: a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data. RESULTS: there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011). CONCLUSIONS: there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.

Primary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases / Atención primaria en salud complementaria: evaluación de costos en el cuidado de ancianos con enfermedades del corazón / Atenção primária na saúde suplementar: avaliação de custos no cuidado de pacientes idosos com cardiopatias

ABSTRACT Objectives: to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases. Methods: a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data. Results: there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011). Conclusions: there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.

RESUMEN Objetivos: identificar si la implementación de un sistema complementario de Atención Primaria de Salud (APS) permite reducir los costos de atención a los ancianos con enfermedades del corazón. Métodos: cohorte retrospectiva de 223 pacientes con cardiopatía de edad ≥ 60 años. Los datos fueron obtenidos de prontuarios y bases de datos de costos, evaluados por un período de un año antes y después de la implementación de la APS. Los resultados se expresaron como frecuencias absolutas medias por número de hospitalizaciones y como gasto anual medio expresado en dólares (US$) en relación con los datos de costes. Resultados: hubo reducción de los gastos de hospitalización después de la implementación de la APS complementaria (p=0,01) y disminución de la frecuencia de hospitalizaciones para toda la muestra (p=0,006). Hubo reducción en la frecuencia de consultas en Emergencia entre los ancianos frágiles (p=0,011). Conclusiones: hubo una reducción en los costos de hospitalización y frecuencia de visitas a la Sala de Emergencia después de la APS complementaria.

RESUMO Objetivos: identificar se a implementação de um sistema de Atenção Primária à Saúde (APS) suplementar possibilita a redução dos custos assistenciais de idosos com cardiopatias. Métodos: coorte retrospectiva de 223 pacientes cardiopatas com idade ≥ 60 anos. Os dados foram obtidos em registros médicos e banco de dados de custos, avaliados por período de um ano antes e após a implementação da APS. Os resultados foram expressos como media das frequências absolutas para número de internações e como gasto médio anual expressos em dólares (US$) em relação aos dados de custos. Resultados: houve redução nas despesas de internação após a implementação da APS suplementar (p=0,01) e diminuição da frequência de internação para toda a amostra (p=0,006). Houve redução na frequência de consultas no Pronto Atendimento entre os idosos frágeis (p=0,011). Conclusões: houve redução nos custos de internação e frequência de consulta no Pronto Atendimento após a APS suplementar.

Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

Downregulation of CD73 on CD4+ T cells from patients with chronic Chikungunya infection.

Chikungunya is an important mosquito-borne disease caused by the arthritogenic chikungunya virus, characterized by sporadic outbreaks all around the world. Although CD4+ T cells seem to have an important role in the pathogenesis of chikungunya, the mechanisms involved in this process are not yet fully elucidated. The ectoenzymes CD39 and CD73, also expressed by CD4 T lymphocytes, are involved in the hydrolysis of pro-inflammatory extracellular ATP and generation of immunosuppressive adenosine and seem to be modulated in some arthritogenic pathologies. However, their involvement in Chikungunya disease is unclear. Thus, using flow cytometry, we investigated peripheral CD4+ T cells from patients with acute and chronic chikungunya to assess the expression of ectonucleotidases CD39 and CD73 and coinhibitory receptors and production of cytokine and cytolytic granules. Patients in the acute phase displayed increased levels of PD-1, CTLA-4, IL-10, and IFN-γ compared to healthy individuals and patients in the chronic phase. Moreover, during chronic Chikungunya, analyses of Mean Fluorescent Intensity (MFI) demonstrated a reduced density of LAP, Perforin and Granzyme B compared to the healthy control. Finally, reduced levels of the ectoenzymes CD39 and CD73 expression was found during the chronic phase suggesting a possible modulation of extracellular ATP and adenosine by CD4+ T cells that may be involved in the persistence of arthritogenic symptoms.

Regulatory T cells in acute and chronic human Chikungunya infection.

Chikungunya virus (CHIKV) infection generates strong immune responses that are associated with the disease pathophysiology. Regulatory T cells (Treg-cluster of differentiation (CD)-4+CD25highforkhead box P3 (FOXP3+)) are essential for the induction and maintenance of peripheral tolerance. Thus, they play key roles in determining the patient prognosis by preventing excessive immune responses via different suppression immune mechanisms. However, the regulatory mechanisms involved in human CHIKV infection are still poorly understood. Here, we characterize for the first time the Treg cell molecule-associated-mechanism during acute and chronic human Chikungunya disease. Here, we assessed the Treg cell population and molecule-associated mechanism in the peripheral blood samples of acute and chronic patients with Chikungunya. Our results indicate that CHIKV infection is associated with reduced frequency of Tregs, along with the impaired expression and production of Treg functional markers, including CD39, CD73, perforin, granzyme, programmed death 1 (PD-1), cytotoxic T lymphocyte antigen (CTLA)-4, and transforming growth factor (TGF)-ß. This observation suggests that Treg cells possess the poor regulatory capacity in both acute and chronic phases of the disease. Taken together, these data provide significant evidence that the imbalanced response of Treg cells plays an essential role in establishing the pathogenesis of Chikungunya.

Quando édipo encontra Lábdaco: Sobre o complexo de édipo entre um avô e uma neta à luz da psicanálise vincular / When oedipus meets Lábdaco: About the oedipus complex between a grandfather and a granddaughter in the light of Links Psychoanalysis / Cuando edipo encuentra Lábdaco: Sobre el complejo de edipo entre un abuelo y una nieta a la luz de Psicoanálisis Vincular

O complexo de Édipo é até hoje um dos conceitos mais centrais no campo da psicanálise e se refere a uma dada situação familiar prototípica que supostamente atravessa todo sujeito no decorrer de seu desenvolvimento emocional. Tendo o conceito passado por diversas revisões, complementações e críticas ao longo do tempo, e, embora tenha perdido seu caráter universal, não ocorrendo necessariamente entre pai, mãe e criança, como acreditava Freud, ainda assim tem sua importância. Entretanto, são poucos os trabalhos que abordam outras dinâmicas relacionais na família, para além do relacionamento pais e filhos. Este artigo se propõe a contribuir para o estudo específico do vínculo entre avós e netos, por meio de um relato de caso bastante particular acerca de um complexo edípico envolvendo esse tipo de dupla. O aporte teórico da psicanálise vincular foi eleito por ser um referencial que enfatiza o âmbito intersubjetivo e o todo familiar, podendo, assim, melhor abarcar uma reflexão aprofundada sobre essa temática.

The Oedipus complex is to this day one of the most central concepts in the field of psychoanalysis and refers to a given prototypical family situation that supposedly crosses every subject in the course of his emotional development. Since the concept has undergone several revisions, complements and criticisms over time, and although it has lost its universal character, not necessarily occurring between father, mother and child, as Freud believed, it still has its importance. However, few studies deal with other relational dynamics in the family, in addition to the relationship between parents and children. This article proposes to contribute to the specific study of the bond between grandparents and grandchildren, through a very particular case report about an oedipal complex involving this type of pair. The theoretical contribution of the links psychoanalysis was chosen because it is a reference that emphasizes the intersubjective scope and the family, and, therefore, better to include a deep reflection on this theme.

El complejo de Edipo es hasta hoy uno de los conceptos más centrales en el campo del psicoanálisis y se refiere a una determinada situación familiar prototípica que supuestamente atraviesa a todo sujeto en el transcurso de su desarrollo emocional. Con el concepto pasado por diversas revisiones, complementaciones y críticas a lo largo del tiempo, y, aunque ha perdido su carácter universal, no ocurriendo necesariamente entre padre, madre y niño, como creía Freud, todavía tiene su importancia. Sin embargo, son pocos los trabajos que abordan otras dinámicas relacionales en la familia, además de la relación padres e hijos. Este artículo se propone contribuir al estudio específico del vínculo entre abuelos y nietos, por medio de un relato de caso bastante particular acerca de un complejo edípico envolviendo ese tipo de doble. El aporte teórico del psicoanálisis vincular fue elegido por ser un referencial que enfatiza el ámbito intersubjetivo y el todo familiar, pudiendo así mejor abarcar una reflexión profundizada sobre esa temática.

Trabalhando o vínculo, trabalhando no vínculo: considerações sobre o papel da transferência no atendimento de crianças e jovens que sofreram rupturas familiares / Working the bond, working in the bond: considerations about the role of transfer in the care of children and young people who have suffered family breaks / Trabajar el vínculo, trabajar en el vínculo: consideraciones sobre el papel de la transferencia en el cuidado de los niños y jóvenes que han sufrido descansos familiares

O objetivo deste trabalho é refletir acerca de situações de rupturas familiares, que geram consequências importantes para a formação do self, e sobre a possibilidade de elaboração frente a esperança produzida pela construção de novos vínculos. Quais as reverberações dessas rupturas familiares no processo de constituição da identidade e no desenrolar da própria transferência num atendimento de orientação psicanalítica? Numa tentativa de responder a essa pergunta, será destacado aqui o vínculo transferencial como promotor de uma potencialidade terapêutica.

The main objective of the present paper is, based on the psychoanalytic theory (specially Winnicott's considerations), to reflect about situations regarding the rupture of family links, which cause relevant consequences to the construction of the self of a child, and about the possibility of elaboration with the development of new links. Considering those ruptures, what are the reverberations in the process of identity constitution and, considering the analysis environment, in the outcome of the transference itself? To answer this question, it will be highlighted in the present paper the bond between analyst and patient as a promoter of a therapeutic potentiality.

El objetivo desto trabajo es refletir acerca de situaciones de rupturas familiares y las consecuencias que estas tienen en la formación del self, y acerca de la posibilidad de elaboración frente a la esperanza producida por la construcción de novos vinculos. ¿Quales son las reverberaciones de esas rupturas familiares en los procesos de constitución de la identidad y en el desenvolvimiento de la propia transferencia en un atendimiento de orientación psicoanalítica? En una tentativa de responder a essa pregunta, será destacado aqui el vínculo transferencial como promotor de una potencialidad terapeutica.

Phenotypical characterization of regulatory T cells in acute Zika infection.

Zika virus (ZIKV), alongside Dengue virus (DENV), Chikungunya virus (CHIKV), and Yellow Fever Virus (YFV) are prevalent arboviruses in the Americas. Each of these infections is associated with the development of associated disease immunopathology. Immunopathological processes are an outcome of counter-balancing impacts between effector and regulatory immune mechanisms. In this context, regulatory T cells (Tregs) are key in modulating the immune response and, therefore, in tissue damage control. However, to date, Treg phenotypes and mechanisms during acute infection of the ZIKV in humans have not been fully investigated. The main aim of this work was to characterize Tregs and their immunological profile related to cytokine production and molecules that are capable of controlling the exacerbated inflammatory profile in acute Zika infected patients. Using whole blood analyses of infected patients, an ex vivo phenotypical characterization of Tregs, circulating during acute Zika virus infection, was conducted by flow cytometry. We found that though there are no differences in absolute Treg frequency between infected and healthy control groups. However, pro-inflammatory cytokine up-regulation such as IFN-γ and LAP was observed in the acute disease. Furthermore, acute ZIKV patients expressed increased levels of CD39/CD73, perforin/granzyme B, PD-1, and CTLA-4, all markers involved in mechanisms used by Tregs to attempt to control strong inflammatory responses. Thus, the data indicates a potential contribution of Tregs during the inflammatory ZIKV infection response.

Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents.

OBJECTIVES: To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS: This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS: The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION: In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents

OBJECTIVES: To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS: This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS: The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION: In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Desafios e atuação da Vigilância Sanitária no enfrentamento da Covid-19 no Estado do Paraná / Challenges and actions of the Health Surveillance in coping with Covid-19 in the State of Paraná

A pandemia da Covid-19 apresentou uma necessidade tempestiva de intensificação das medidas de prevenção e controle sanitário, o que pautou a Vigilância Sanitária e a trouxe como importante aliada às demais áreas para este enfrentamento. Este estudo apresenta um relato de experiência da atuação da Vigilância Sanitária do Paraná e dos desafios encontrados frente a Covid-19, mediante uma análise descritiva das ações desenvolvidas e dos dados registrados no sistema SIEVISA. Os resultados apontam uma atuação diversificada e interdisciplinar, por meio de elaboração de Notas Orientativas e Resoluções, e da execução de ações educativas e de fiscalização. No SIEVISA, foram registradas 7.535 ações relacionadas à Covid-19, executadas de forma descentralizada. Com isso constatou-se a necessidade de transpor obstáculos e de fomentar o uso do sistema SIEVISA. Por fim, a pandemia e a necessidade de enfrentá-la de forma coesa, concreta e coerente fortaleceram a importância do trabalho integrado e articulado em equipe. (AU)

The Covid-19 pandemic needs a timely and effective intensification for preventive and health control measures, so the Health Surveillance came into attention and has become an important ally articulated with other areas for this confronting. This study aims to present an experience report of the Paraná Health Surveillance performance and challenges encountered in the face of Covid-19, through a descriptive analysis of the actions developed and the data recorded in the SIEVISA system. The results showed a diverse and interdisciplinary work by the elaboration of Guidance Notes and Resolutions, the realization of guidelines and training, also the execution of educational and inspection actions. In SIEVISA, 7,535 actions related to Covid-19 were registered, carried out in a decentralized manner. For this, there was a need both to overcome problems, as well as to encourage the use of the SIEVISA system. Finally, the pandemic and the need to face it the cohesive, concrete and coherent way strengthened the importance of integrated and articulated teamwork. (AU)

Estratégias protetivas, administrativas e ambientais para a saúde dos trabalhadores durante a pandemia / Estrategias de protección, administrativas y ambientales para la salud de los trabajadores durante la pandemia / Protective, administrative and environmental strategies for workers' health during the pandemic

Objetivo: identificar publicações com indicativos de enfrentamento que enfatizem as estratégias protetivas, administrativas e ambientais descritas na literatura científica utilizadas para a prevenção e controle da infecção pelo novo Coronavírus, em trabalhadores da saúde. Método: revisão integrativa de literatura realizada em junho de 2020 em sete bases de dados da área da saúde. Utilizou-se como descritores: "Health Personnel", "Covid-19", "Decision Making, Organizational", "Containment of Biohazards", "Personal Protective Equipment" "Risk Management". Resultados: amostra de 13 artigos, os quais observou-se a todas estratégias preconizadas pela Organização Mundial de Saúde no enfrentamento às doenças de contexto pandêmico. Conclusões: a associação de estratégias não foi recorrente. A gravidade situação se desdobrou como terreno fértil para a construção de experiências inovadoras e colaborativas.(AU)

Objective: to identify publications with coping indications that emphasize the protective, administrative and environmental strategies described in the scientific literature used for the prevention and control of infection by the new coronavirus, in health workers. Method: integrative literature review carried out in June 2020 in seven health databases. It was used as descriptors: "Health Personnel", "Covid-19", "Decision Making, Organizational", "Containment of Biohazards", "Personal Protective Equipment" "Risk Management". Results: 13 articles, which observed all strategies recommended by the World Health Organization coping with pandemic diseases Conclusions: the association of strategies was not recurrent. The seriousness of the situation has unfolded as a fertile ground for the construction of innovative and collaborative experiences.(AU)

Objetivo: identificar publicaciones con indicaciones de afrontamiento que enfaticen las estrategias protectoras, administrativas y ambientales descritas en la literatura científica utilizada para la prevención y control de la infección por el nuevo coronavirus, en trabajadores de salud. Método: revisión integradora de la literatura realizada en junio de 2020 en siete bases de datos de salud. Se utilizaron los siguientes descriptores: "Health Personnel", "Covid-19", "Decision Making, Organizational", "Containment of Biohazards", "Personal Protective Equipment" "Risk Management". Resultados: muestra de 13 artículos, que observaron todas las estrategias recomendadas por la Organización Mundial de la Salud para hacer frente a las enfermedades en un contexto pandémico. Conclusiones: la asociación de estrategias no fue recurrente. La gravedad de la situación se ha desplegado como un terreno fértil para la construcción de experiencias innovadoras y colaborativas.(AU)

A preparação de crianças e adolescentes para adoção: o lugar do estudante de psicologia / The preparation of children and adolescents for adoção: the psychology student's place / La preparación de niños y adolescentes en la adopcón: el lugar del estudiante de psicologia

Esse artigo tem como objetivo refletir acerca da participação do estudante de Psicologia, incluído em programa de estágio supervisionado, na preparação de crianças, adolescentes e grupo de irmãos para a inserção em família adotiva. Numa revisão de literatura, propostas interventivas voltadas à preparação tanto no âmbito da adoção nacional quanto da internacional são apresentadas. Por meio de vinhetas clínicas e de um enfoque psicanalítico, discutimos a importância de um diálogo interdisciplinar entre a academia, o judiciário e as instituições de acolhimento voltados para a consolidação dos vínculos entre crianças/adolescentes e os adotantes. Abordamos, ainda, o lugar do terapeuta/estagiário e os limites de sua atuação, constituindo-se em experiência rica para seu desenvolvimento pessoal e profissional, bem como para a construção de conhecimento para a área (AU).

This article aims to reflect on the participation of the psychology student included in a supervised internship program, in the preparation of children, adolescents and group of siblings for insertion into an adoptive family. It is presented some intervention proposals aimed at preparing both in the scope of national and international adoption based on the review of the literature. Through clinical reports and a psychoanalytic approach, it is discussed the importance of an interdisciplinary dialogue between the academy, the judiciary and the home institutions aimed at consolidating the bonds between children or adolescents and adopters. We also emphasize the therapist trainee's (student) place and the limits of his/her performance constituting a valuable experience for his/her personal and professional development, as well as the construction of knowledge for the area (AU).

Este artículo pretende reflexionar sobre la participación del estudiante de psicología incluida en el programa de prácticas supervisadas en la preparación de los niños, adolescentes y grupo de hermanos para su inserción en familia sustituta. En una revisión de la literatura se presentan propuestas de intervención dirigidas a preparar a la adopción nacional e internacional. A través de viñetas clínicas y de un enfoque psicoanalítico discutimos la importancia de un diálogo interdisciplinario entre la academia, el poder judicial y las instituciones de acogida destinadas a la consolidación de los vínculos entre niños y adolescentes y adoptantes. Se discute el lugar del terapeuta/aprendiz y los límites de su actuar, siendo rica experiencia para su desarrollo personal y profesional, así como para la construcción del conocimiento en el área (AU).

De quem é a preocupação primária?: A teoria winnicottiana e o cuidado parental na contemporaneidade / Who is concerned with primary preoccupation?: Winnicott's theory and parental care in contemporary times / ¿De quién es la preocupación primaria?: La teoría winnicottiana y el cuidado parental en la contemporaneidad

Face às inúmeras transformações ocorridas nas últimas décadas no interior da família, este artigo tem o objetivo de investigar a parentalidade contemporânea, tendo como base teórica uma revisão do conceito winnicottiano de preocupação materna primária. Partindo de um estudo qualitativo, discutir-se-á o material oriundo de entrevistas semidirigidas realizadas com dois casais heterossexuais de classe média brasileira, com filhos de até três anos de idade, cuja participação masculina em termos de tempo dedicado aos cuidados com as crianças fosse semelhante ou superior à da mulher. Os resultados indicam que a preocupação primária pode ser desenvolvida também nos homens, o que nos leva a propor que se desvincule este conceito de determinismos biológicos e que seja adotada a denominação "preocupação parental primária". A maior participação masculina não se configurou como ameaça à relação mãe-bebê. E, assim como os homens podem oferecer holding à relação mãe-bebê, as mulheres também podem oferecê-lo à relação pai-bebê.

In view of the numerous transformations that have taken place in recent decades within family structure and functioning, this paper aims at investigating contemporary parenthood, based on a review of Winnicott's concept of primary maternal preoccupation. In order to investigate these issues, this study employs a qualitative approach to analyse semi-structured interviews with two Brazilian middle-class heterosexual couples who are parents of children up to three years old, in which the man's participation, in terms of time devoted to childcare, is similar or greater than the woman's. Results show that primary preoccupation may also be developed in men. Based on that, we propose to detach this concept from biological determinism and adopt the term "primary parental preoccupation". The greater male participation did not figure as a threat to the mother-baby relationship. And just as men can provide holding to the mother-baby relationship, women can also provide holding to the father-baby relationship.

Delante de varias transformaciones ocurridas en las últimas décadas en el interior de la familia, este artigo tiene el objetivo de investigar la parentalidad contemporánea, teniendo como base teórica una revisión del concepto winnicottiano de preocupación materna primaria. Partiéndose de un estudio cualitativo, se discutirá el material oriundo de entrevistas semidirigidas realizadas con dos parejas heterosexuales de clase media brasileña, con hijos de hasta tres años de edad, cuya participación masculina en términos de tiempo dedicado a los cuidados con los niños fuera semejante o superior a la de la mujer. Los resultados indican que la preocupación primaria puede ser desarrollada también en los hombres, lo que nos lleva a proponer que se desvincule este concepto de determinismos biológicos y que sea adoptada la denominación "preocupación parental primaria". La mayor participación masculina no se configuró como amenaza a la relación madre-bebé. Y, así como los hombres pueden ofrecer holding a la relación madre-bebé, las mujeres también lo pueden ofrecer a la relación padre-bebé.

A monoparentalidade por opção e seus aspectos psicossociais: estudo de revisão integrativa / Single parenthood by choice and its psychosocial aspects: an integrative review study / La monoparentalidad por elección y sus aspectos psicosociales: un estudio de revisión integrativa

A monoparentalidade, tradicionalmente relacionada a abandono ou viuvez, vê-se como uma opção familiar na contemporaneidade. Objetivou-se analisar a produção acadêmica acerca dessa escolha filiativa por meio de uma revisão integrativa de artigos publicados na última década nas bases de dados: Scopus, Medline, Web of science, SciELO, Lilacs, BVS e Dedalus. De 77 resultados no levantamento inicial, permaneceram 20 na seleção final. Com prevalência às pesquisas de campo qualitativas, obteve-se estudos realizados só com a população feminina e oriundos de centros economicamente desenvolvidos. Concluiu-se que, a monoparentalidade programada emerge num cenário de mudanças na organização familiar e no papel exercido pela mulher na sociedade, entre a tradição e a inovação, o empoderamento desta e a deficiência nas relações interpessoais.

Single parenthood is traditionally related to abandonment or widowhood, but contemporaneously it is observed the development of single-parent families by choice. The objective of this research was to review the academic production about the psychosocial aspects involved in this choice. An integrative review of the articles published between 2008 and 2018 was carried out in the databases: Scopus, Medline, Web of science, SciELO, Lilacs, BVS and Dedalus. The initial survey presented 77 results, remaining 20 in the final selection. With the prevalence of qualitative field researches, studies were carried out only with the female population and from economically developed centers. It is concluded that the single-parent families by choice emerge in a scenario of changes in family organization and the role played by women in society, between tradition and innovation, between women's empowerment and disability in interpersonal relationships.

La monoparentalidad está tradicionalmente relacionada con el abandono o la viudez, pero contemporáneamente se observa el desarrollo de familias monoparentales por elección. Se objetivó entonces revisar la producción académica acerca de los aspectos psicosociales que intervienen en tal opción. Se realizó una revisión integrativa de los artículos publicados entre 2006 y 2016 en las bases de datos: Scopus, Medline, Web of Science, SciELO, Lilacs, BVS y Dedalus. El levantamiento inicial presentó 77 resultados, permanecieron 20 en la selección final. Prevalecieron las investigaciones de campo cualitativo, se obtuvieron estudios realizados sólo con la población femenina y oriundos de centros económicamente desarrollados. Se concluye que la monoparentalidad por elección emerge en un escenario de cambios en la organización familiar y en el papel ejercido por la mujer en la sociedad, entre la tradición y la innovación, entre el empoderamiento de la mujer y la deficiencia en las relaciones interpersonales.

Correlation of dengue incidence and rainfall occurrence using wavelet transform for João Pessoa city.

Dengue, a reemerging disease, is one of the most important viral diseases transmitted by mosquitoes. In this study, 55,680 cases of dengue between 2007 and 2015 were reported in Paraíba State, among which, 30% were reported in João Pessoa city, with peaks in 2015, 2011 and 2013. Weather is considered to be a key factor in the temporal and spatial distribution of vector-transmitted diseases. Thus, the relationship between rainfall occurrence and dengue incidences reported from 2007 to 2015 in João Pessoa city, Paraíba State, Brazil, was analyzed by means of wavelet transform, when a frequency analysis of both rainfall and dengue incidence signals was performed. To determine the relationship between rainfall and the incidence of dengue cases, a sample cross correlation function was performed to identify lags in the rainfall and temperature variables that might be useful predictors of dengue incidence. The total rainfall within 90 days presented the most significant association with the number of dengue cases, whereas temperature was not found to be a useful predictor. The correlation between rainfall and the occurrence of dengue cases showed that the number of cases increased in the first few months after the rainy season. Wavelet analysis showed that in addition to the annual frequency presented in both time series, the dengue time series also presented the 3-year frequency from 2010. Cross wavelet analysis revealed that such an annual frequency of both time series was in phase; however, after 2010, it was also possible to observe 45° up phase arrows, which indicated that rainfall in the present year led to an increased dengue incidence the following year. Thus, this approach to analyze surveillance data might be useful for developing public health policies for dengue prevention and control.

Evaluation of the enantioselective in vitro metabolism of the chiral pesticide fipronil employing a human model: Risk assessment through in vitro-in vivo correlation and prediction of toxicokinetic parameters.

The chiral pesticide fipronil is employed as a racemic mixture to control pests. Although there are no enantioselective differences in the fipronil enantiomer activities toward target organisms, fipronil enantiomers may exhibit enantioselective differences in their bioaccumulation, toxicity, and metabolism toward non-target organisms, including humans. The present work aims to provide significant reliable enantioselective information concerning fipronil risk assessment in humans. For that, the in vitro metabolism of rac-fipronil, S-fipronil, and R-fipronil by human liver microsomes was evaluated, the in vivo enantioselective toxicokinetic parameters were predicted and the main CYP450 isoforms involved in the enantioselective metabolism were determined. The obtained results demonstrated that fipronil may undergo a clearance by the liver and it is exclusively metabolized by the CYP3A4 isoform. Although no significative stereoselective differences were observed, the results provide reliable information on fipronil risk assessment for humans.

A study about the characteristics of the contemporary parental exercise and care network / Um estudo acerca das características do exercício parental contemporâneo e a respectiva rede de cuidados

Considering the transformations that have occurred in the ways contemporary families operate, we propose an investigation on how heterosexual couples understand and exercise parenting, as well as on how they deal with the child care network. Based on qualitative methodology, 8 couples and their children's pediatricians and educational coordinators were interviewed. The analysis of the results covered two categories: (1) The Construction of Parenthood and Care Network, and (2) Parental Exercise. Interviews were analyzed based on the perspective of psychoanalysis and psychosocial studies. We identified three possibilities for parenthood appropriation: (a) greater fluidity in parental roles, (b) egalitarian parental care, in which a greater value was assigned to the maternal figure, especially in the discourse made by parents and; (c) disruption with gender binarism in the parental exercise, but with a predominance of the responsibility for child care assigned to one of the spouses. As for sharing child care related tasks, both pediatricians and schools were seen as important parental tools.

Diante das transformações que ocorreram no funcionamento das famílias contemporâneas, o presente estudo propõe uma investigação acerca de como casais heterossexuais compreendem e exercem a parentalidade, e de como lidam com a rede de cuidados. A pesquisa, de metodologia qualitativa, entrevistou oito casais, assim como os pediatras e coordenadores educacionais de seus filhos. A análise dos resultados abrangeu duas categorias: (1) Construção da parentalidade e rede de cuidados, e (2) Exercício parental. As interpretações fundamentaram-se na psicanálise e nos estudos psicossociais. Identificaram-se três possibilidades de apropriação da parentalidade: (a) maior fluidez nos papéis parentais, (b) cuidado parental igualitário, com predomínio, no discurso dos pais, de atribuição de maior valor à figura materna; e c) rompimento com o binarismo de gênero no exercício parental, mas com predomínio da responsabilidade de um dos cônjuges em relação aos cuidados com os filhos. Quanto ao compartilhamento dos cuidados, tanto pediatras quanto as escolas foram referidos como importantes auxiliares dos pais.

Egalitarian Parental Care: literature review and conceptual construction / Cuidado Parental Igualitário: revisão de literatura e construção conceitual

Abstract This literature review discusses how the concept ofegalitarian parental careis constructed as a representation of the new dynamic in parents/children relations in the contemporary world. To achieve this goal, it retrieves national and international scientific publications in the last five years and focus, as a matter of priority, on the psychological perspective. Results were presented according to data distribution between areas of knowledge, methods, international and national occurrence. Analysis was based on the following categories: assumptions for an ideal egalitarian family, contemporary parenting, parenting versus work versus professional career, and egalitarian parental care. Conclusion shows that egalitarian parental care is a trend in contemporary parenthood construction and demand further investigation in diverse contexts.

Resumo Esta revisão de literatura tem o objetivo de, por meio do levantamento da produção científica nacional e internacional dos últimos cinco anos, discutir a construção do conceitocuidado parental igualitário, enquanto representação de uma nova dinâmica de funcionamento da relação pais/filhos(as) na contemporaneidade, priorizando o enfoque da Psicologia. Os resultados serão apresentados em função da distribuição da produção por: áreas de estudo, metodologias utilizadas, incidência mundial e incidência nacional. O corpus de análise foi aprofundado em torno das categorias: pressupostos para um ideal igualitário de família; parentalidade contemporânea; parentalidade versus trabalho versus carreira profissional; e cuidado parental igualitário. Conclui-se que o cuidado parental igualitário constitui uma tendência na construção da parentalidade contemporânea que demanda maiores investigações em contextos diversificados.