The effect of a dermato-oncological training programme on the diagnostic skills and quality of referrals for suspicious skin lesions by general practitioners.

BACKGROUND: The rising incidence rates of skin cancer (SC) lead to an enormous burden on healthcare systems. General practitioners (GPs) might play an important part in SC care, but research has shown poor clinical recognition of SC, leading to a high rate of potentially unnecessary referrals. OBJECTIVES: The aim of this study was to evaluate if a dermato-oncological training programme (DOTP) for GPs improved their diagnostic skills and quality of referrals. METHODS: Out of 194 GPs in the Nijmegen area, 83 (42·8%) followed a DOTP on SC. Referrals from both a trained cohort (TC) and two cohorts of untrained GPs [untrained present cohort (UPC) and untrained historical cohort (UHC)] were included. Data on diagnostic skills, quality of referrals and the number of potentially unnecessary referrals were evaluated. RESULTS: A total number of 1662 referrals were analysed. The referral diagnosis was correct more often in the TC (70·3%) compared with the UPC (56·2%; P < 0·001) and the UHC (51·6%; P < 0·001). Furthermore, the TC also provided a better lesion description, mentioned a diagnosis more often in their referral letters and more often performed diagnostics before referral. In addition, fewer potentially unnecessary referrals were identified in the TC compared with the UPC (62·7% vs. 73·7%; P < 0·001) and the UHC (75·2%; P < 0·001). CONCLUSIONS: GPs who followed a DOTP had better diagnostic skills and quality of referrals than untrained GPs, leading to fewer potentially unnecessary referrals. This might enhance a more efficient use of the limited capacity in secondary dermatological care and consequently lead to lower healthcare costs.

Preoperative imaging for colorectal liver metastases: a nationwide population-based study.

BACKGROUND: In patients with colorectal liver metastases (CRLM) preoperative imaging may include contrast-enhanced (ce) MRI and [18 F]fluorodeoxyglucose (18 F-FDG) PET-CT. This study assessed trends and variation between hospitals and oncological networks in the use of preoperative imaging in the Netherlands. METHODS: Data for all patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were retrieved from a nationwide auditing database. Multivariable logistic regression analysis was used to assess use of ceMRI, 18 F-FDG PET-CT and combined ceMRI and 18 F-FDG PET-CT, and trends in preoperative imaging and hospital and oncological network variation. RESULTS: A total of 4510 patients were included, of whom 1562 had ceMRI, 872 had 18 F-FDG PET-CT, and 1293 had combined ceMRI and 18 F-FDG PET-CT. Use of ceMRI increased over time (from 9·6 to 26·2 per cent; P < 0·001), use of 18 F-FDG PET-CT decreased (from 28·6 to 6·0 per cent; P < 0·001), and use of both ceMRI and 18 F-FDG PET-CT 16·9 per cent) remained stable. Unadjusted variation in the use of ceMRI, 18 F-FDG PET-CT, and combined ceMRI and 18 F-FDG PET-CT ranged from 5·6 to 100 per cent between hospitals. After case-mix correction, hospital and oncological network variation was found for all imaging modalities. DISCUSSION: Significant variation exists concerning the use of preoperative imaging for CRLM between hospitals and oncological networks in the Netherlands. The use of MRI is increasing, whereas that of 18 F-FDG PET-CT is decreasing.

ANTECEDENTES: En pacientes con metástasis hepáticas colorrectales (colorrectal liver metastases, CRLM), los estudios de imagen preoperatorios pueden incluir resonancia magnética con contraste (ce)MRI y 18 F-FDG-PET-CT. Este estudio evaluó las tendencias y la variación entre los hospitales y las redes oncológicas en el uso de estudios de imagen preoperatorios en los Países Bajos. MÉTODOS: Todos los pacientes que se sometieron a una resección hepática por CRLM en los Países Bajos entre 2014 y 2018 fueron seleccionados a partir de una base de datos a nivel nacional auditada. El análisis de regresión logística multivariable se utilizó para evaluar el uso de ceMRI, de 18 F-FDG-PET-CT y de ceMRI combinado con 18 F-FDG-PET-CT, así como para determinar las tendencias en los estudios de imagen preoperatorios y las variaciones hospitalarias y de la red oncológica. RESULTADOS: En total, se incluyeron 4.510 pacientes, de los cuales 1.562 se sometieron a ceMRI, 872 a 18 F-FDG-PET-CT y 1.293 a ceMRI combinado con 18 F-FDG-PET-CT. El uso de ceMRI aumentó con el tiempo del 9,6% al 26,2% (P < 0,001), el uso de 18 F-FDG-PET-CT disminuyó (25% a 6,0%, P < 0,001) y el uso de ceMRI y 18 F-FDG-PET- CT (17%) se mantuvo estable. La variación no ajustada entre hospitales en el uso de ceMRI, 18 F-FDG-PET-CT y la combinación de ceMRI y 18 F-FDG-PET-CT oscilaba del 5% al 10%. Después de la corrección por case-mix, la variación hospitalaria y de la red oncológica persistía en todas las pruebas de imagen. CONCLUSIÓN: En los Países Bajos existe una variación significativa entre hospitales y redes oncológicas respecto al uso de pruebas de imagen preoperatorias para el CRLM. El uso de MRI está aumentando, mientras que el uso de 18 F-FDG-PET-CT está disminuyendo.

Volume-outcome relationship of liver surgery: a nationwide analysis.

BACKGROUND: Evidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit. METHODS: This was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien-Dindo grade IIIA or higher) and 30-day or in-hospital mortality. RESULTS: A total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20-69) procedures. Overall major morbidity and mortality rates were 11·2 and 2·0 per cent respectively. The mortality rate was 1·9 per cent after resection for colorectal liver metastases (CRLMs), 1·2 per cent for non-CRLMs, 0·4 per cent for benign tumours, 4·9 per cent for hepatocellular carcinoma and 10·3 per cent for biliary tumours. Higher-volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events. CONCLUSION: Hospital volume and postoperative outcomes were not associated.

ANTECEDENTES: La asociación entre el volumen hospitalario y los resultados de la cirugía hepática no está clara. Según la recomendación actual de las guías holandesas se requiere un volumen mínimo de 20 procedimientos anuales por centro. El objetivo de este estudio fue analizar la asociación entre el volumen hospitalario con los resultados postoperatorios en la auditoría hepatobiliar obligatoria holandesa a nivel nacional. MÉTODOS: Se realizó un estudio a nivel nacional en los Países Bajos. Se incluyeron todas las resecciones hepáticas registradas en la auditoría hepatobiliar holandesa entre 2014 y 2017. El volumen anual del centro se calculó y se clasificó en categorías de 20 procedimientos por año. Los objetivos principales fueron la morbilidad de mayor grado (Clavien-Dindo grado IIIA o superior) y la mortalidad hospitalaria o la mortalidad a los 30 días. RESULTADOS: Se realizaron un total de 5.590 resecciones en 34 centros con una mediana (rango intercuartílico) de volumen anual de 35 procedimientos (20-69). La tasa global de morbilidad mayor fue del 11% y la mortalidad del 2%. La mortalidad fue de 1,9% después de la resección por metástasis hepáticas colorrectales (colorectal liver metastases, CRLM), 1,2% para no CRLM, 0,4% para tumores benignos, 4,9% para carcinoma hepatocelular, y 10,3% para tumores biliares. Los centros de mayor volumen realizaron más resecciones hepáticas mayores y más resecciones por carcinoma hepatocelular y cáncer biliar. En el análisis multivariable después de ajustar por factores de riesgo conocidos de eventos adversos, no se observó ninguna asociación entre el volumen hospitalario y la morbilidad o mortalidad mayor. CONCLUSIÓN: No hubo asociación entre el volumen hospitalario y los resultados postoperatorios de la cirugía hepática en los Países Bajos.

Grading immunohistochemical markers p16INK4a and HPV E4 identifies productive and transforming lesions caused by low- and high-risk HPV within high-grade anal squamous intraepithelial lesions.

OBJECTIVES: Because current guidelines recognise high-grade anal squamous intraepithelial lesions (HSILs) and low-grade SILs (LSILs), and recommend treatment of all HSILs although not all progress to cancer, this study aims to distinguish transforming and productive HSILs by grading immunohistochemical (IHC) biomarkers p16INK 4a (p16) and E4 in low-risk human papillomavirus (lrHPV) and high-risk (hr)HPV-associated SILs as a potential basis for more selective treatment. METHODS: Immunostaining for p16 and HPV E4 was performed and graded in 183 biopsies from 108 HIV-positive men who have sex with men. The causative HPV genotype of the worst lesion was identified using the HPV SPF10-PCR-DEIA-LiPA25 version 1 system, with laser capture microdissection for multiple infections. The worst lesions were scored for p16 (0-4) to identify activity of the hrHPV E7 gene, and panHPV E4 (0-2) to mark HPV production and life cycle completion. RESULTS: There were 37 normal biopsies, 60 LSILs and 86 HSILs, with 85% of LSILs caused by lrHPV and 93% of HSILs by hrHPV. No normal biopsy showed E4, but 43% of LSILs and 37% of HSILs were E4 positive. No differences in E4 positivity rates were found between lrHPV and hrHPV lesions. Most of the lesions caused by lrHPV (90%) showed very extensive patchy p16 staining; p16 grade in HSILs was variable, with frequency of productive HPV infection dropping with increasing p16 grade. CONCLUSIONS: Combined p16/E4 IHC identifies productive and nonproductive HSILs associated with hrHPV within the group of HSILs defined by the Lower Anogenital Squamous Terminology recommendations. This opens the possibility of investigating selective treatment of advanced transforming HSILs caused by hrHPV, and a 'wait and see' policy for productive HSILs. What's already known about this topic? For preventing anal cancer in high-risk populations, all patients with high-grade squamous intraepithelial lesions (HSILs) are treated, even though this group of lesions is heterogeneous, the histology is variable and regression is frequent. What does this study add? By adding human papillomavirus (HPV) E4 immunohistochemistry to p16 INK4a (p16), and grading expression of both markers, different biomarker expression patterns that reflect the heterogeneity of HSILs can be identified. Moreover, p16/E4 staining can separate high-risk HPV-associated HSILs into productive and more advanced transforming lesions, providing a potential basis for selective treatment.

Anal Squamous Intraepithelial Lesions (SILs) in Human Immunodeficiency Virus-Positive Men Who Have Sex With Men: Incidence and Risk Factors of SIL and of Progression and Clearance of Low-Grade SILs.

BACKGROUND: Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at risk of anal squamous cell carcinoma. Data are limited on the natural history of the precursor to this carcinoma, anal squamous intraepithelial lesions (SILs). METHODS: HIV-positive MSM were screened for histopathological SILs by means of high-resolution anoscopy (HRA). For participants without SILs at baseline, we estimated the cumulative incidence and risk factors for SILs. For those with low-grade SILs (LSILs) at baseline, the risk of progression to high-grade SILs (HSILs) and the clearance rate were estimated at the lesion level. RESULTS: Of 807 men without SILs at baseline, 107 underwent follow-up HRA between 1 to 4.5 years later. At the second visit 18 men (16.8%) showed LSIL, and 25 (23.4%) HSIL. Age was associated with incident LSILs (adjusted odds ratio [aOR], 2.10 per 10-year increase in age; P = .01). Of 393 men with LSILs at baseline, 114 underwent follow-up HRA 0.5 to 2.5 years later. Of the 177 LSILs found at baseline, 87 (49.2%) had cleared at the second visit, and 29 (16.4%) had progressed to HSILs. CONCLUSION: Incident LSILs and HSILs were common during follow-up among HIV-positive MSM without dysplasia at baseline. Among men with LSILs at baseline, nearly half of these lesions cleared, and a small portion progressed.

Vaginal and anal human papillomavirus infection and seropositivity among female sex workers in Amsterdam, the Netherlands: Prevalence, concordance and risk factors.

BACKGROUND: We studied prevalence, risk factors and concordance of vaginal and anal HPV infection and L1 seropositivity among female sex workers (FSW) in Amsterdam. METHODS: In 2016, FSW aged ≥18 years having a sexually transmitted infections (STI) consultation were invited to participate. Participation entailed taking vaginal and anal self-swabs. Demographics and sexual behaviour data were collected. HPV DNA was analysed using the SPF10-PCR-DEIA-LiPA25-system-v1. Serum was tested for HPV L1 antibodies using multiplex serology assays. Determinants of vaginal and anal high risk HPV (hrHPV) infection and L1 seropositivity were assessed with logistic regression analyses. RESULTS: We included 304 FSW; median age was 29 years (IQR 25-37). Vaginal and anal hrHPV prevalence were 46% and 55%, respectively. HrHPV L1 seropositivity was 37%. Vaginal-anal hrHPV concordance was strong, but no significant association between vaginal or anal hrHPV infection and seropositivity was found. Having had anal sexual contact was not associated with anal hrHPV infection (P = 0.119). DISCUSSION: Vaginal and anal hrHPV prevalence is high among FSW in Amsterdam, the Netherlands. Promotion of HPV vaccination, preferably at the beginning of the sex (work) career, may be a useful prevention method against hrHPV infection and disease.

Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis.

The prognostic significance of histological regression in primary melanoma has been debated for many years. We aim to review the evidence to see how histological regression may affect prognosis. A systematic review was performed by searching in MEDLINE, Scopus and the Cochrane Library from 1 January 1966 to 1 August 2015. All studies reporting hazard ratios or data on survival and histological regression were included. Primary random-effects meta-analyses were used to summarize outcome measures. Heterogeneity was assessed using the χ2 -test and I2 -statistic. To assess the potential bias of small studies we used funnel plots and the Begg and Mazumdar adjusted rank correlation method. Summaries of survival outcomes were measured as hazard ratios or relative risk of death at 5 years according to the presence of histological regression of primary melanoma. In total, 183 articles were reviewed out of 1876 retrieved. Ten studies comprising 8557 patients were included. Patients with histological regression had a lower relative risk of death (0·77, 95% confidence interval 0·61-0·97) than those without. Examination of the funnel plot did not provide evidence of publication bias. The results showed that histological regression is a protective factor for survival.

Uma cartografia das repercussões das redes sociais na subjetividade / One cartography of social networks effects on the subjectivity / Uma cartografía de repercusiones de las redes sociales en la subjetividad

O objetivo deste artigo é mapear as possíveis repercussões ou influências das redes sociais de internet na subjetividade de seus usuários. As concepções e sentidos subjacentes à vivência dos participantes, em termos da autoapresentação e interação nesse ambiente, constituíram-se no objeto de estudo desta investigação. A metodologia fundamentou-se na pesquisa qualitativa com base na observação participante e em entrevistas semiestruturadas com 16 participantes do facebook, de ambos os sexos, de diferentes idades, etnias e níveis socioeconômicos. A interpretação dos dados foi efetuada por meio de um diálogo entre a concepção de subjetividade prêt-à-porter e noções da psicanálise. Como fatores positivos, constatou-se o potencial de ampliação das formas de sociabilidade, de aprendizagem, de empoderamento e de elaboração psíquica. Por outro lado, evidenciaram-se o risco de inversão do tempo de produção e de socialização e a ocorrência do sentido de vigiar e ser vigiado. Os resultados ressaltam ainda outros elementos da subjetividade dos usuários que se tornaram visíveis e articuláveis por meio de textos e imagens, trazendo consigo novos desafios não somente para o dispositivo psicoanalítico e para aqueles que atuam com saúde mental, mas também para os demais profissionais de áreas afins à psicologia, educação e saúde.

The aim of this study is to map the potential repercussion or influences of online social networks on the subjectivity of its users. The conceptions and the underlying meanings from the experiences of the participants, in terms of self-presentation and interaction in this environment, constituted the object of study of this investigation. The methodology was based on a qualitative study with basis on semi-structured interviews with sixteen Facebook users, of both sexes, different ages, ethnicities, and socioeconomic levels. Data interpretation was performed through a dialogue between the conception of prêt-à-porter subjectivity and notions from psychoanalysis. As positive factors, the potential to expand the forms of sociability, learning, empowerment, and psychic elaboration was confirmed. On the other hand, the risk of investing production and socialization time, and the occurrence of the sense of watching and being watched. The results also highlighted the eruption elements of subjectivity of users which have become visible and articulated through texts and images, bringing with it new challenges not only for the psychoanalytic device and for those who work with mental health, but also for other professionals areas related to psychology, education and health.

El objetivo de este artículo es mapear las posibles repercusiones o influencias de las redes sociales de internet en la subjetividad de los usuarios. Las concepciones y significados simbólicos subyacentes a las experiencias de los participantes, en términos de auto-presentación e interacción en este medio, se constituyeron en el objeto de estudio de esta investigación. La metodología se fundamentó en la investigación cualitativa con base en la observación participante y en entrevistas semiestructuradas con dieciséis participantes de Facebook, de ambos sexos, de diferentes edades, etnias y niveles socioeconómicos. La interpretación de los datos se realizó por medio de un diálogo entre la concepción de la subjetividad prêt-à-porter y nociones del psicoanálisis. Como factores positivos, se constató el potencial de expansión de las formas de sociabilidad, de aprendizaje y de elaboración psíquica. Se evidenció el riesgo de invertir el tiempo de producción y la socialización, y la ocurrencia del sentido de vigilar y ser vigilado. Por otro lado, los resultados resaltaron aún otros elementos de la subjetividad de los usuarios que se han hecho visibles y articuladas por medio de textos e imágenes, trayendo con él nuevos desafíos no solamente para el dispositivo psicoanalítico y para aquellos que actúan con la salud mental, sino también para profesionales de áreas afines a la psicología, educación y salud.

Opacidade das fronteiras entre real e virtual na perspectiva dos usuários do Facebook / Opacité des frontières entre réel et virtuel dans la perspective des utilisateurs de Facebook / Opacidad de las fronteras entre real y virtual en la perspectiva de los usuarios del Facebook / Opacity of the boundaries between real and virtual worlds from the perspective of Facebook users

Resumo: Este artigo analisa a relação entre o mundo real e o virtual com base na perspectiva dos jovens usuários da maior rede social do mundo, o Facebook. Para a consecução do objetivo, esta pesquisa ouviu, por meio de entrevistas semiestruturadas, dez jovens usuários de ambos os sexos residentes no Distrito Federal. Os dados foram analisados sob a perspectiva interdisciplinar, particularmente respaldada em teorias interpretativas oriundas da psicologia social e da antropologia sociocultural. Evidenciou-se que os participantes concebem essas duas categorias como distintas uma da outra, na medida em que cada uma possui suas especificidades e relações de diferença e de similaridade. Constatou-se ainda que as vivências subjetivas dos sujeitos pesquisados acabam criando uma espécie de continuum cuja existência encontra-se justaposta entre cada um desses ambientes, tornando opacas ou movediças as fronteiras entre ambos.

Résumé: Cet article analyse la relation entre le monde réel et le virtuel dans la perspective des jeunes utilisateurs du plus grand réseau social du monde: le Facebook. Pour atteindre cet objectif, cette étude a interrogé, avec d'entretiens semi-structurés, dix jeunes utilisateurs du réseau, des deux sexes, résidants au District Fédéral brésilien. Les données ont été analysées dans une perspective interdisciplinaire, particulièrement soutenue par les théories interprétatives issues de la Psychologie Sociale et de l'Anthropologie Socioculturelle. Il est devenu évident que les participants conçoivent ces deux catégories en tant que distinctes l'une de l'autre, à la mesure où chacune comporte ses propres particularités et ses relations de différence et de similarité. Il a également été constaté que les expériences subjectives des sujets de recherche finissent par créer une sorte de continuum, dont l'existence est juxtaposée entre chacun de ces environnements et deviennent opaque ou déplace des frontières entre eux.

Resumen: Este artículo analiza la relación entre el mundo real y el virtual desde la perspectiva de los jóvenes usuarios de la mayor red social del mundo, el Facebook. Para lograr el objetivo, se entrevistó, mediante entrevistas semi-estructuradas, diez jóvenes usuarios de la red de ambos los sexos residentes en el Distrito Federal. Los datos fueron analizados desde una perspectiva interdisciplinaria, particularmente apoyada en teorías interpretativas oriundas de la psicología social y antropología sociocultural. Se evidenció que los participantes conciben a estas dos categorías como distintas una de la otra, pero manteniendo relaciones de similitud y diferencia. Se observó, además, que las vivencias subjetivas de los sujetos de la investigación terminan creando una especie de continuum cuya la existencia se encuentra yuxtapuesta entre cada uno de estos ambientes, convirtiendo en opaca o movediza las fronteras entre ellos.

Abstract: This article analyzes the relationship between the real and virtual worlds from the perspective of young users of the world's largest social network, Facebook. To achieve the objective, this research involved conducting semi-structured interviews with ten young male and female users of the network who were residing in the Brazilian Federal District. Data were analyzed from an interdisciplinary perspective, particularly supported by interpretive theories derived from Social Psychology and Sociocultural Anthropology. It was evident that participants conceive these two categories as distinct from one another, each with its own peculiarities, but maintaining relationships of similarities and differences. A further observation was that the subjective experiences of the research subjects ended up creating a kind of continuum whose existence is juxtaposed between each of these environments, with the boundaries between them becoming opaque or shifting.

Opacidade das fronteiras entre real e virtual na perspectiva dos usuários do Facebook / Opacité des frontières entre réel et virtuel dans la perspective des utilisateurs de Facebook / Opacidad de las fronteras entre real y virtual en la perspectiva de los usuarios del Facebook / Opacity of the boundaries between real and virtual worlds from the perspective of Facebook users

Este artigo analisa a relação entre o mundo real e o virtual com base na perspectiva dos jovens usuários da maior rede social do mundo, o Facebook. Para a consecução do objetivo, esta pesquisa ouviu, por meio de entrevistas semiestruturadas, dez jovens usuários de ambos os sexos residentes no Distrito Federal. Os dados foram analisados sob a perspectiva interdisciplinar, particularmente respaldada em teorias interpretativas oriundas da psicologia social e da antropologia sociocultural. Evidenciou-se que os participantes concebem essas duas categorias como distintas uma da outra, na medida em que cada uma possui suas especificidades e relações de diferença e de similaridade. Constatou-se ainda que as vivências subjetivas dos sujeitos pesquisados acabam criando uma espécie de continuum cuja existência encontra-se justaposta entre cada um desses ambientes, tornando opacas ou movediças as fronteiras entre ambos.(AU)

Cet article analyse la relation entre le monde réel et le virtuel dans la perspective des jeunes utilisateurs du plus grand réseau social du monde: le Facebook. Pour atteindre cet objectif, cette étude a interrogé, avec d'entretiens semi-structurés, dix jeunes utilisateurs du réseau, des deux sexes, résidants au District Fédéral brésilien. Les données ont été analysées dans une perspective interdisciplinaire, particulièrement soutenue par les théories interprétatives issues de la Psychologie Sociale et de l'Anthropologie Socioculturelle. Il est devenu évident que les participants conçoivent ces deux catégories en tant que distinctes l'une de l'autre, à la mesure où chacune comporte ses propres particularités et ses relations de différence et de similarité. Il a également été constaté que les expériences subjectives des sujets de recherche finissent par créer une sorte de continuum, dont l'existence est juxtaposée entre chacun de ces environnements et deviennent opaque ou déplace des frontières entre eux.(AU)

Este artículo analiza la relación entre el mundo real y el virtual desde la perspectiva de los jóvenes usuarios de la mayor red social del mundo, el Facebook. Para lograr el objetivo, se entrevistó, mediante entrevistas semi-estructuradas, diez jóvenes usuarios de la red de ambos los sexos residentes en el Distrito Federal. Los datos fueron analizados desde una perspectiva interdisciplinaria, particularmente apoyada en teorías interpretativas oriundas de la psicología social y antropología sociocultural. Se evidenció que los participantes conciben a estas dos categorías como distintas una de la otra, pero manteniendo relaciones de similitud y diferencia. Se observó, además, que las vivencias subjetivas de los sujetos de la investigación terminan creando una especie de continuum cuya la existencia se encuentra yuxtapuesta entre cada uno de estos ambientes, convirtiendo en opaca o movediza las fronteras entre ellos.(AU)

This article analyzes the relationship between the real and virtual worlds from the perspective of young users of the world's largest social network, Facebook. To achieve the objective, this research involved conducting semi-structured interviews with ten young male and female users of the network who were residing in the Brazilian Federal District. Data were analyzed from an interdisciplinary perspective, particularly supported by interpretive theories derived from Social Psychology and Sociocultural Anthropology. It was evident that participants conceive these two categories as distinct from one another, each with its own peculiarities, but maintaining relationships of similarities and differences. A further observation was that the subjective experiences of the research subjects ended up creating a kind of continuum whose existence is juxtaposed between each of these environments, with the boundaries between them becoming opaque or shifting.(AU)

HPV vaccination intention among male clients of a large STI outpatient clinic in Amsterdam, the Netherlands.

We explored HPV vaccination intention and its determinants among male clients of the sexually transmitted infections (STI) clinic in Amsterdam. In 2015, male clients aged ≥18 years were invited to complete a web-based questionnaire regarding HPV vaccination intention and socio-psychological determinants. Determinants (scale -3 to +3) were assessed with linear regression, stratified for men who have sex with men (MSM) (including men who have sex with men and women) and men who only have sex with women (MSW). Additionally, we explored the effect of out-of-pocket payment on intention. Of 1490 participants (median age 33 years [IQR:25-44]), 1,053(71%) were MSM. HPV vaccination intention was high (mean 1.68, 95%CI:1.55-1.81 among MSW; mean 2.35, 95%CI:2.29-2.42 among MSM). In multivariable analyses, socio-psychological determinants had similar effects on intention in both groups (R2=0.70 among MSW; R2=0.68 among MSM), except for subjective norms, self-efficacy, and HPV knowledge (significantly stronger associations among MSW). HPV vaccination intention decreased significantly when vaccination would require out-of-pocket payment; intention was negative at the current list price (€350). HPV vaccination intention among male clients of the Amsterdam STI-clinic is high and variance in intention was mostly be explained by socio-psychological factors. Out-of-pocket payment had a strong negative effect on HPV vaccination intention.

Repercussões das Redes Sociais na Subjetividade: Narcisismo, Felicidade e Elaboração Psíquica / Repercussions of Social Networks on Subjectivity: Narcissism, Happiness and Psychic Elaboration

O presente artigo constitui-se em um ensaio teórico. Originou-se de uma pesquisa empírica cujo um dos principais objetivos foi analisar a possibilidade de elaboração psíquica de conflitos pessoais, de lutos e de dificuldades próprias por meio das interações e da participação nas redes sociais de internet. Tendo como ponto de partida os resultados obtidos nesta investigação, o presente trabalho tem como objetivo realizar uma análise teórica sobre essa possibilidade de elaboração psíquica como uma repercussão das redes sociais na subjetividade dos usuários. Considerando as evidências empíricas da correlação entre a exaltação de aspectos narcisistas e o bem-estar ou o mal-estar dos usuários em pesquisas recentes, o conceito de narcisismo foi elencado como ponto de convergência para uma interlocução entre a perspectiva crítica da denominada cultura do narcisismo, a crítica da felicidade e a concepção freudiana de narcisismo e de elaboração psíquica. A conclusão a que se chegou é a de que, embora hajaexaltação de uma suposta felicidade narcisista e individualista nessas redes, a possibilidade de elaboração psíquica, mediante a expressão nas redes sociais, surge também como possível repercussão do uso dessas redes sociais na subjetividade dos usuários

Estetização do self e elaboração psíquica: repercussões das redes sociais na subjetividade / Aestheticization of the self and psychic elaboration: effects of social networks on subjectivity / Estilización del Self y elaboración psíquica: repercusiones de las redes sociales en la subjetividad

O objetivo deste artigo é analisar as possíveis repercussões das redes sociaisde Internet na subjetividade dos usuários. As concepções e significados simbólicossubjacentes à vivência dos participantes (autoapresentação e interação nesse ambiente)constituíram-se no objeto de estudo desta investigação. A metodologia fundamentou-sena pesquisa qualitativa com base em entrevistas semiestruturadas com dezesseisparticipantes do Facebook, de ambos os sexos, de diferentes idades, etnias e níveissocioeconômicos, todos residentes em Brasília-DF. Partindo da concepção de Negociaçãode Identidades, elaborada por Rosa e Santos (2013), a interpretação dos dados foiefetuada a partir de uma perspectiva interdisciplinar, particularmente respaldada porteorias interpretativas oriundas da Psicanálise e da Antropologia Sociocultural. Comoresultado, constatou-se a existência de um processo dialético de produção subjetiva ede elaboração psíquica entre os usuários das redes sociais que ocorre mediante ofenômeno da estetização do self. Este resultado demonstra os primeiros indícios dacondição de possibilidade de que as redes sociais de Internet sejam consideradas como“um lugar de escritura”, demarcando novos horizontes para a Psicologia na atualidade(AU)

The objective of this paper is to analyze the potential impact of online socialnetworks on the subjectivity of its users. The conceptions and the underlying symbolicmeanings from the experiences of the participants (self-presentation and interaction inthis environment) constituted the object of study of this investigation. The methodologywas based on a qualitative study with basis on semi-structured interviews with sixteenFacebook users, of both sexes, different ages, ethnicities, and socioeconomic levels,all residents in Brasilia. Starting from the concept of Identity Negotiation, developed byRosa and Santos (2013), the data interpretation was performed through aninterdisciplinary perspective, particularly supported by interpretative theories arisingfrom Psychoanalysis and Sociocultural Anthropology. As a result, the existence of adialectical process of subjective production and psychic elaboration between users ofsocial networks was detected, which occurs through the phenomenon of theaestheticization of the self. This result shows the first signs of the condition of possibility that Internet social networks could be considered as “a place of scripture,” staking outnew horizons for the Psychology today(AU)

El objetivo de este trabajo es analizar las posibles repercusiones de lasredes sociales de Internet en la subjetividad de los usuarios. Las concepciones ysignificados simbólicos que subyacen a la experiencia de los participantes (autopresentación e interacción en este entorno) se constituyen como objeto de estudio deesta investigación. La metodología empleada fue de tipo investigación cualitativa basadaen entrevistas semi-estructuradas con dieciséis participantes de Facebook, de ambossexos, de diferentes edades, etnias y niveles socioeconómicos, todos los residentesen Brasilia-DF. Partiendo del concepto de Negociación de Identidades, desarrolladopor Rose y Santos (2013), la interpretación de los datos fue realizada desde unaperspectiva interdisciplinaria, principalmente respaldada por las teorías interpretativasderivadas del Psicoanálisis y la Antropología Sociocultural. Como resultado, se encontróque hay un proceso dialéctico de producción subjetiva y de elaboración psíquica entrelos usuarios de las redes sociales que ocurre a través del fenómeno de la Estilizacióndel self. Este resultado muestra los primeros indicios de la posible condición de quelas redes sociales de Internet son considerados como “un lugar de la Escritura,”replanteando nuevos horizontes para la psicología en la actualidad(AU)

Repercussões das redes sociais na subjetividade: narcisismo, felicidade e elaboração psíquica / Repercussions of social etworks on subjectivity: narcissism, happinss and psychic elaboration

O presente artigo constitui-se em um ensaio teórico. Originou-se de uma pesquisa empírica cujo um dos principais objetivos foi analisar a possibilidade de elaboração psíquica de conflitos pessoais, de lutos e de dificuldades próprias por meio das interações e da participação nas redes sociais de internet. Tendo como ponto de partida os resultados obtidos nesta investigação, o presente trabalho tem como objetivo realizar uma análise teórica sobre essa possibilidade de elaboração psíquica como uma repercussão das redes sociais na subjetividade dos usuários. Considerando as evidências empíricas da correlação entre a exaltação de aspectos narcisistas e o bem-estar ou o mal-estar dos usuários em pesquisas recentes, o conceito de narcisismo foi elencado como ponto de convergência para uma interlocução entre a perspectiva crítica da denominada cultura do narcisismo, a crítica da felicidade e a concepção freudiana de narcisismo e de elaboração psíquica. A conclusão a que se chegou é a de que, embora hajaexaltação de uma suposta felicidade narcisista e individualista nessas redes, a possibilidade de elaboração psíquica, mediante a expressão nas redes sociais, surge também como possível repercussão do uso dessas redes sociais na subjetividade dos usuários

This paper consists of a theoretical essay based on an empirical research that has as one of its aim to analyze the possibility of psychic elaboration of personal conflicts, of mourning and of one’s own issues through interaction and participation in online social networks. From the results obtained in this investigation, this work seeks to conduct a theoretical analysis on the possibility of psychic elaboration as a repercussion of social networks on the subjectivity of users. Considering the empirical evidence of a correlation between the exaltation of narcissistic aspects and the welfare of users in recent researches, the concept of narcissism was cast as the convergence point for a dialogue between the critical perspective of the so-called culture of narcissism, the critique of happiness and the Freudian concept of narcissism and psychic elaboration. The conclusion to which we come is that, although a supposed narcissistic and individualistic happiness is exalted in these networks, the possibility of psychic elaboration by means of the expression in these social networks also emerged as possible repercussions of using these networks on the subjectivity of users.

Facebook: negociação de identidades e o medo da violência / Facebook: negotiation of identities and fear of violence / Facebook: negociación de identidades y el miedo a la violencia

Este artigo analisa os fatores que orientam a composição do perfil dos usuários do Facebook e sua participação nessa rede social, processo que denominamos de negociação de identidade. Seu foco é a tensão entre privacidade e publicidade, intimidade e exposição nas redes sociais. A metodologia consistiu em uma pesquisa qualitativa com base em entrevistas com dez jovens usuários do Facebook, de ambos os sexos, todos residentes em Brasília-DF. O resultado indica o medo da violência como um dos principais condicionantes dos traços identificadores selecionados na composição dos perfis e em participações na rede. Os entrevistados alegaram não expor suas vidas profissionais e pessoais, preservando-as da violência urbana. Constatamos, assim, que os usuários do Facebook sentem insegurança no mundo virtual, sendo essa uma demonstração de que o medo se encontra inscrito nas subjetividades dos indivíduos, o que torna opaca uma suposta barreira entre os mundos real e virtual(AU)

This paper analyzes the factors that guide the composition of the profile of Facebook users and the participation of the subjects in this social network, a process that we are calling negotiation of identity. Its focus is on the tension between privacy and publicity, intimacy and exposure in social networks.The methodology is based on qualitative research methods, and on in-depth interviews with ten young Facebook users, of both sexes, all of them living in Brasilia-DF. The result indicates the fear of violence as one of the main determinants of identifying features in the composition of the selected profiles and network shares. The respondents claimed not to expose their professional and personal lives, for preserving them against the urban violence. We find, therefore, that Facebook users feel insecure in the virtual world, this being a demonstration that fear has entered in the subjectivities of individuals, which becomes opaque the supposed barrier between the real and the virtual worlds(AU)

Este artículo examina los factores que guían la composición del perfil de los usuarios de Facebook y su participación en esta red social, proceso que llamamos negociación de identidades. Su enfoque es la tensión entre la privacidad y la publicidad, la intimidad y la exposición en redes sociales. La metodología consistió en una investigación cualitativa basada en entrevistas con diez jóvenes usuarios de Facebook, de ambos sexos, todos residentes en Brasilia-DF. El resultado indica el miedo a la violencia como una de las principales condiciones de selección de los rasgos identificadores en la composición de los perfiles y en la participación en la red. Los encuestados afirmaron no exponer sus vidas profesionales y personales para preservarlas de la violencia urbana. Encontramos, por tanto, que los usuarios del Facebook sienten inseguridad en el mundo virtual, siendo esta una demostración de que el miedo está inscripto en las subjetividades de los individuos, lo que torna opaca una supuesta barrera entre el mundo real y el virtual(AU)

Facebook: negociação de identidades e o medo da violência / Facebook: negotiation of identities and fear of violence / Facebook: negociación de identidades y el miedo a la violencia

Este artigo analisa os fatores que orientam a composição do perfil dos usuários do Facebook e sua participação nessa rede social, processo que denominamos de negociação de identidade. Seu foco é a tensão entre privacidade e publicidade, intimidade e exposição nas redes sociais. A metodologia consistiu em uma pesquisa qualitativa com base em entrevistas com dez jovens usuários do Facebook, de ambos os sexos, todos residentes em Brasília-DF. O resultado indica o medo da violência como um dos principais condicionantes dos traços identificadores selecionados na composição dos perfis e em participações na rede. Os entrevistados alegaram não expor suas vidas profissionais e pessoais, preservando-as da violência urbana. Constatamos, assim, que os usuários do Facebook sentem insegurança no mundo virtual, sendo essa uma demonstração de que o medo se encontra inscrito nas subjetividades dos indivíduos, o que torna opaca uma suposta barreira entre os mundos real e virtual...

This paper analyzes the factors that guide the composition of the profile of Facebook users and the participation of the subjects in this social network, a process that we are calling negotiation of identity. Its focus is on the tension between privacy and publicity, intimacy and exposure in social networks.The methodology is based on qualitative research methods, and on in-depth interviews with ten young Facebook users, of both sexes, all of them living in Brasilia-DF. The result indicates the fear of violence as one of the main determinants of identifying features in the composition of the selected profiles and network shares. The respondents claimed not to expose their professional and personal lives, for preserving them against the urban violence. We find, therefore, that Facebook users feel insecure in the virtual world, this being a demonstration that fear has entered in the subjectivities of individuals, which becomes opaque the supposed barrier between the real and the virtual worlds...

Este artículo examina los factores que guían la composición del perfil de los usuarios de Facebook y su participación en esta red social, proceso que llamamos negociación de identidades. Su enfoque es la tensión entre la privacidad y la publicidad, la intimidad y la exposición en redes sociales. La metodología consistió en una investigación cualitativa basada en entrevistas con diez jóvenes usuarios de Facebook, de ambos sexos, todos residentes en Brasilia-DF. El resultado indica el miedo a la violencia como una de las principales condiciones de selección de los rasgos identificadores en la composición de los perfiles y en la participación en la red. Los encuestados afirmaron no exponer sus vidas profesionales y personales para preservarlas de la violencia urbana. Encontramos, por tanto, que los usuarios del Facebook sienten inseguridad en el mundo virtual, siendo esta una demostración de que el miedo está inscripto en las subjetividades de los individuos, lo que torna opaca una supuesta barrera entre el mundo real y el virtual...