Especialização em Auditoria do SUS: entrevista com Yohhan Garcia de Souza

Do-It-Yourself Artificial Pancreas System and the OpenAPS Movement.

People with diabetes have been experimenting with and modifying their own diabetes devices and technologies for many decades in order to achieve the best possible quality of life and improving their long-term outcomes, including do-it-yourself (DIY) closed loop systems. Thousands of individuals use DIY closed loop systems globally, which work similarly to commercial systems by automatically adjusting and controlling insulin dosing, but are different in terms of transparency, access, customization, and usability. Initial outcomes seen by the DIY artificial pancreas system community are positive, and randomized controlled trials are forthcoming on various elements of DIYAPS technology.

16. Diabetes Advocacy: Standards of Medical Care in Diabetes-2019.

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Activism and human rights for people with mental disabilities in postcommunist Europe.

Disability activists emerged as an important influence over the first decade of the new millennium in postcommunist Central and Eastern Europe, a particularly critical time for progress in human rights and services for people with mental disabilities in that part of the world. An entrenched custodial institutional infrastructure existed for children and adults with mental disabilities in communist Central and Eastern Europe between the 1940s and the fall of communism in 1989. Activists who emerged in the subsequent postcommunist era faced multiple challenges and important new opportunities in their efforts to address human rights and quality of life for citizens with mental disabilities. Critical to their efforts were new civil society freedoms that allowed for the establishment of nongovernmental organizations (NGOs), which had previously been prohibited. Those activists and NGOs tended to represent one of two distinct missions: Either a focus on human rights protection with a watch-dog function, or an emphasis on service-provision and community-based support. Across both types of activism and NGO missions, the goal to reduce the imposition of custodial institutional life on people with mental disabilities was a priority. In addition to the history of mental disability activism in postcommunist Central and Eastern Europe, this article addresses the implications for American psychologists involved in cross-cultural and international work in disability issues, and notes the challenges facing psychologists who are engaged in both activism and the profession. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Los espacios de la locura en la Toscana del siglo XVIII: estrategias y negociaciones para enfrentar la enfermedad mental / The spaces of madness in Eighteenth-Century Tuscany. Strategies and negotiations to deal with mental afflictions

Este trabajo estudia los diferentes espacios en que aparece registrada la locura en el Gran Ducado de Toscana durante el siglo XVIII. A partir de la revisión de expedientes de interdicción por incapacidad mental, archivos de justicia criminal, archivos de policía y registros hospitalarios, propone una aproximación a la historia de la locura basada en el análisis comprensivo de las vinculaciones entre las distintas instancias en que se debatió sobre sus características, se evaluaron sus consecuencias y se elaboraron estrategias para hacerle frente. Este enfoque revela que las alternativas existentes para sobrellevar la enfermedad mental funcionaban como respuestas temporales y flexibles que constituían una red de instancias que podían ser recorridas de distintas maneras. Sugiere que el estudio de estos itinerarios, sus actores y lenguajes resulta fundamental para comprender en toda su magnitud la forma en que fueron concebidas y enfrentadas las perturbaciones mentales en el siglo XVIII. En particular, sostiene que su funcionamiento dio pie a un debate social sobre los indicadores y significados de la locura que serviría de insumo para la sistematización del conocimiento psiquiátrico

This study explores the different spaces where madness was recorded in the Grand Duchy of Tuscany during the eighteenth century. Drawing from interdiction procedures, criminal records, records of the police and hospital records, it proposes an approach to the history of madness based on a comprehensive analysis of the connections between the different spaces where people debated about the characteristics and consequences of madness and developed strategies to deal with it. This analytical strategy discloses that the mechanisms for dealing with madness were temporary and flexible responses that functioned as a network that could follow different courses. The study suggests that these itineraries, its agents and languages are essential to fully grasp how mental afflictions were conceived and managed in the eighteenth century. Particularly, it argues that the way they functioned gave origin to a social debate about the indicators and signs of madness that contributed to the systematization of psychiatric knowledge

Organizing seniors to protect the health safety net: the way forward.

Over the past century, the organized voice of seniors has been critical in building the U.S. health safety net. Since the 2016 election, that safety net, particularly the Medicaid program, is in jeopardy. As we have seen with the rise of the Tea Party, senior support for health care programs-even programs that they use in large numbers-cannot and should not be taken for granted. This article provides a brief history of senior advocacy and an overview of the current senior organizing landscape. It also identifies opportunities for building the transformational organizing of low-income seniors needed to defend against sustained attacks on critical programs. Several suggestions are made, drawn from years of work in philanthropy, advocacy, and campaigns, for strengthening the ability to organize seniors-particularly low-income seniors-into an effective political force advocating for Medicaid and other safety net programs.

"The Service I Rendered Was Just as True": African American Soldiers and Veterans as Activist Patients.

In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as "policy actors" who viewed health and medical care as "politics by other means." In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans' health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system's precedent-setting desegregation, referred to by advocates of the time as "a shining example to the rest of the country."

Justice or Injustice: a History and Critique of the New York State Justice Center for the Protection of People with Special Needs.

The creation of the New York State Justice Center for the Protection of People with Special Needs ("Justice Center") was announced with great fanfare in 2013. Its goal is laudable: strengthening and standardizing "the safety net for vulnerable persons, adults and children alike, who are receiving care from New York's human service agencies and programs." Its jurisdiction is broad: covering residential and non-residential programs and provider agencies that come within the purview of six state oversight agencies, namely, the Office of Mental Health, the Office for People with Developmental Disabilities, the Office of Alcohol and Substance Abuse Services, the Office of Children and Family Services, the Department of Health, and the State Education Department. Its powers are comprehensive: investigating allegations of abuse, neglect, and significant incidents, and disciplining individuals and agencies pursuant to administrative authority. In addition, it can prosecute crimes of neglect and abuse pursuant to criminal prosecutorial authority. Given that over 270,000 vulnerable children and adults live in residential facilities overseen by the state and that numerous other individuals receive services from "day programs operated, licensed[,] or certified by the state[,]" the creation of the Justice Center is consistent with New York's history of oversight of vulnerable individuals. The state has overseen various state and municipal programs and private organizations that have addressed the needs of vulnerable individuals practically since New York's first poorhouse opened in 1736. The development of that oversight has been a series of responses to perceived deficiencies of an existing system, and the creation of the Justice Center is, much in the same way, a response to a 2011 study commissioned by the Governor to examine the treatment and care of vulnerable adults. The Justice Center's jurisdiction reflects a departure, however, from traditional oversight. State administrative and regulatory review has been carried out by specialized state agencies established during the late nineteenth and twentieth centuries to address specific categories of individuals receiving care and treatment according to their needs. Residential and day treatment programs, as well as their custodians and employees, have been disciplined for abuse and neglect in accordance with state regulations created by these agencies. Criminal prosecutions have also been referred to county district attorneys. The Justice Center unites all specialized agencies, all vulnerable individuals with diverse needs, and all custodians and employees trained to meet those needs under one additional layer of uniform rules and regulations, with potential administrative discipline, civil liability, and criminal prosecution also under the same umbrella. This article explores the history of state oversight in New York and the departure represented by the Justice Center. This article first traces the early history of oversight. It then discusses the role of the Commission on Quality of Care for the Mentally Disabled, an antecedent organization similar to the Justice Center. Next, it examines the Justice Center itself. Last, this article concludes with some reflections on the Center.