The drivers and impacts of Amazon forest degradation.

Approximately 2.5 × 106 square kilometers of the Amazon forest are currently degraded by fire, edge effects, timber extraction, and/or extreme drought, representing 38% of all remaining forests in the region. Carbon emissions from this degradation total up to 0.2 petagrams of carbon per year (Pg C year-1), which is equivalent to, if not greater than, the emissions from Amazon deforestation (0.06 to 0.21 Pg C year-1). Amazon forest degradation can reduce dry-season evapotranspiration by up to 34% and cause as much biodiversity loss as deforestation in human-modified landscapes, generating uneven socioeconomic burdens, mainly to forest dwellers. Projections indicate that degradation will remain a dominant source of carbon emissions independent of deforestation rates. Policies to tackle degradation should be integrated with efforts to curb deforestation and complemented with innovative measures addressing the disturbances that degrade the Amazon forest.

Entrega em adoção e demanda de reencontro à justiça: motivações da genitora / Voluntary relinquishment and request to justice for reunion: birth mother's motivations / Entrega en adopción y solicitud de reencuentro a la justicia: motivaciones de la madre biológica

Mudanças legislativas em relação à adoção vêm trazendo importantes repercussões para a compreensão do instituto. Neste artigo, temos como objetivo discutir especificidades da entrega voluntária de uma criança para adoção, no contexto da Justiça, e as motivações de demanda posterior da genitora para a viabilização de um reencontro. Problematizamos a amplitude do direito de acesso às origens, assegurado em lei aos adotados, a partir do entrelaçamento das temáticas entrega e reencontro, procurando compreender essas experiências pela perspectiva da genitora. Este trabalho parte de um caso paradigmático, atendido em uma Vara da Infância, Juventude e Idoso no estado do Rio de Janeiro, que culminou com o contato, mediado pelo Poder Judiciário, entre a adotada e sua genitora, por iniciativa desta. Trata-se de um estudo qualitativo, no qual foi realizada uma entrevista semiestruturada com a genitora, quatro anos após o acolhimento de seu pedido à Justiça. Os dados obtidos na entrevista foram analisados por meio do método de análise de conteúdo, em sua vertente categorial, resultando em duas categorias: entrega em adoção e segredos; reencontro: motivações e trajetórias. Constatamos a ausência de publicações brasileiras sobre a temática do reencontro, apontando que o assunto ainda é um tabu. Identificamos que, após o reencontro com a filha, foi possível à genitora uma transformação de si mesma, favorecendo o rompimento do segredo da entrega e de parte de sua história. Assinalamos a necessidade de mais pesquisas, incluindo-se a possibilidade da inserção do Judiciário na mediação dessas demandas.(AU)

Legislative changes related to adoption have brought important repercussions for understanding its regulations. In this article, we aim to discuss the peculiarities of a voluntary relinquishment of a child for adoption, in the context of justice, and the motivations of subsequent demand from the birth mother to set a reunion. We problematize the dimension of the right to access origins, guaranteed by law to adoptees, based on the intertwining of the themes voluntary relinquishment and reunion, seeking to understand these experiences from the perspective of the biological mother. This work is based on a paradigmatic case, attended at a Juvenile Court in the State of Rio de Janeiro, that culminated on the reunion of the adopted and her birth mother, at the initiative of the latter, mediated by the Judiciary. This is a qualitative study, in which we interviewed the biological mother, four years after her legal requirement. The data obtained in the interview were analyzed using the content analysis method, in its categorical aspect, resulting in two categories: voluntary relinquishment in adoption and secrets; reunion: motivations and trajectories. We concluded the absence of Brazilian studies about the theme of reunion, pointing out that the subject still as a taboo. We identified that, after the reunion with the daughter, it was possible for the biological mother to modify herself, favoring the breaking of the secret about the relinquishment and of part of her story. We point out the need of more research, including the possibility of inserting the Judiciary as a mediator for such demands.(AU)

Los cambios legislativos respecto a la adopción han tenido importantes repercusiones en la comprensión de la materia. Este artículo pretende discutir los detalles de la entrega espontánea de un niño para adopción, en el contexto de la Justicia, y las motivaciones de la posterior demanda de la madre biológica para hacer factible un reencuentro. Se problematiza la amplitud del derecho de acceso a los orígenes, garantizado por la ley a los adoptados, a partir del entrelazamiento de los temas entrega y reencuentro, analizando estas experiencias desde la perspectiva de la madre biológica. Este trabajo parte de un caso paradigmático que se llevó a cabo en un Juzgado de la Infancia, Juventud y Persona Mayor del Estado de Río de Janeiro y que culminó en el contacto entre la adoptada y su madre, por iniciativa de esta última, mediado por el Poder Judicial. Este estudio cualitativo realizó una entrevista semiestructurada con la madre biológica cuatro años después de su solicitud a la Justicia. A los datos obtenidos en la entrevista se aplicaron el método de análisis de contenido en su vertiente categórica, en el cual surgieron dos categorías: entrega en adopción y secretos; reencuentro: motivaciones y trayectorias. Se encontró que la falta de estudios brasileños sobre reencuentro apunta a que el concepto del sujeto todavía es un tabú. Se constató que luego del encuentro la madre biológica pasó por una autotransformación, lo que favoreció la ruptura del secreto sobre la entrega y parte de su historia. Es necesario realizar más investigaciones sobre el tema, incluida la posibilidad de insertar al Poder Judicial como mediador de tales demandas.(AU)

Oropharyngeal Swallowing Dynamic Findings in People with Asthma.

Airflow obstruction in people with asthma, similar to COPD, may interfere with swallowing, increasing the risk of food or liquid entrance into the lower airways, and favoring the uncontrolled disease. To describe the complaints and findings of the oropharyngeal swallowing mechanisms in patients with mild and severe asthma, a cross-sectional study was performed. A total of 135 participants with asthma were studied, of whom 97 had severe asthma and 38 had mild asthma. All subjects answered a questionnaire with demographic information, disease exacerbations, Asthma Control Questionnaire 6 (ACQ6-Juniper 1999), GastroEsophageal Reflux Disease Symptoms Questionnaire (GERD-SQ-Fornari et al. 2004), and Eating Assessment Tool 10 (EAT-10-Gonçalves et al., 2013). The oral and pharyngeal swallowing assessment occurred via videofluoroscopic swallowing evaluation. The age range of the participants was from 19 to 80 years, with a predominance of females (78.6%). Uncontrolled asthma was observed in 50 (52%) of the patients with severe asthma and in 11 (29%) of the patients with mild asthma (ACQ6 > 1.5). The GERD-SQ and EAT-10 scores were similar in both groups. In the bivariate analysis, the group with severe asthma presented with more changes when compared to the group with mild asthma in the following events: atypical lingual movement during the swallowing of liquid in the volumes of 5 ml (p = 0.003) and 10 ml (p = 0.001), and solid (p = 0.009); oral transit time increased in swallowing of liquid in the volumes of 5 ml (p = 0.003) and 20 ml (p = 0.026); beginning of the pharyngeal swallowing phase below the mandibular ramus (p = 0.003); pharyngeal residue (p = 0.017) of solid consistency; laryngeal penetration of 5 ml (p = 0.050) and 20 ml (p = 0.032) of liquid; increased transition time between the oral and pharyngeal swallowing phases (p = 0.035) and increased pharyngeal transit time (p = 0.045) of solid consistency. Tracheal aspiration was observed only in the group with severe asthma. After the multivariate analysis, atypical tongue movement maintained a statistically significant difference between the two groups. Oropharyngeal swallowing alternations were frequent in the studied sample and more markedly present in patients with severe asthma. Multivariate regression revealed atypical lingual movement, which was greater in patients with severe asthma. The clinical significance of these findings should be further investigated.

Limiting the high impacts of Amazon forest dieback with no-regrets science and policy action.

Large uncertainties still dominate the hypothesis of an abrupt large-scale shift of the Amazon forest caused by climate change [Amazonian forest dieback (AFD)] even though observational evidence shows the forest and regional climate changing. Here, we assess whether mitigation or adaptation action should be taken now, later, or not at all in light of such uncertainties. No action/later action would result in major social impacts that may influence migration to large Amazonian cities through a causal chain of climate change and forest degradation leading to lower river-water levels that affect transportation, food security, and health. Net-present value socioeconomic damage over a 30-year period after AFD is estimated between US dollar (USD) $957 billion (×109) and $3,589 billion (compared with Gross Brazilian Amazon Product of USD $150 billion per year), arising primarily from changes in the provision of ecosystem services. Costs of acting now would be one to two orders of magnitude lower than economic damages. However, while AFD mitigation alternatives-e.g., curbing deforestation-are attainable (USD $64 billion), their efficacy in achieving a forest resilience that prevents AFD is uncertain. Concurrently, a proposed set of 20 adaptation measures is also attainable (USD $122 billion) and could bring benefits even if AFD never occurs. An interdisciplinary research agenda to fill lingering knowledge gaps and constrain the risk of AFD should focus on developing sound experimental and modeling evidence regarding its likelihood, integrated with socioeconomic assessments to anticipate its impacts and evaluate the feasibility and efficacy of mitigation/adaptation options.

Impact of levodopa treatment in the voice pattern of Parkinson's disease patients: a systematic review and meta-analysis.

PURPOSE: Investigate the association between levodopa therapy and vocal characteristics in Parkinson's disease patients. SEARCH STRATEGY: Studies published at MEDLINE, LILACS, and SciELO, from 1960 to December 2016. A systematic review and meta-analysis was performed using the following keywords: Parkinson's disease; levodopa; L-dopa; voice; speech disorders; dysphonia; dysarthria. After analyzing titles and abstracts, two independent reviewers selected all clinical trials that met the eligibility criteria and selected the articles and the data recorded in a previously standardized table. SELECTION CRITERIA: Trials published in English between 1960 and December 2016 individuals with clinical diagnosis of Parkinson's disease; use of levodopa therapy in stable doses; acoustic analysis combined or not with auditory-perceptual analysis to evaluate the vocal parameters under investigation. DATA ANALYSIS: The following vocal parameters were analyzed: fundamental frequency (F 0), jitter, and vocal intensity. Standardized mean differences (SMD) were calculated using the Comprehensive Meta-analysis V2 software. RESULTS: Nine articles met the eligibility criteria and were selected, with a total of 119 individuals. From these, six articles with 83 individuals were included in the meta-analysis. During the levodopa therapy "on" state, modifications in F 0 (SMD=0.39; 95% CI - 0.21-0.57) and jitter (SMD=0.23; 95% CI - 0.02-0.45) were observed. Vocal intensity was not affected (SMD=0.09; 95% CI - 0.22-0.39) by levodopa ingestion. Data of the included studies were controversial in the auditory-perceptual analysis of voice. CONCLUSION: Levodopa therapy modifies F0 and jitter. No changes in vocal intensity were observed in either the "on" or "off" states of levodopa therapy.

Impact of levodopa treatment in the voice pattern of Parkinson's disease patients: a systematic review and meta-analysis / O impacto do tratamento com levodopa na voz de pacientes com doença de Parkinson: revisão sistemática e meta-análise

Abstract Purpose Investigate the association between levodopa therapy and vocal characteristics in Parkinson's disease patients. Search strategy Studies published at MEDLINE, LILACS, and SciELO, from 1960 to December 2016. A systematic review and meta-analysis was performed using the following keywords: Parkinson's disease; levodopa; L-dopa; voice; speech disorders; dysphonia; dysarthria. After analyzing titles and abstracts, two independent reviewers selected all clinical trials that met the eligibility criteria and selected the articles and the data recorded in a previously standardized table. Selection criteria Trials published in English between 1960 and December 2016 individuals with clinical diagnosis of Parkinson's disease; use of levodopa therapy in stable doses; acoustic analysis combined or not with auditory-perceptual analysis to evaluate the vocal parameters under investigation. Data analysis The following vocal parameters were analyzed: fundamental frequency (F 0), jitter, and vocal intensity. Standardized mean differences (SMD) were calculated using the Comprehensive Meta-analysis V2 software. Results Nine articles met the eligibility criteria and were selected, with a total of 119 individuals. From these, six articles with 83 individuals were included in the meta-analysis. During the levodopa therapy "on" state, modifications in F 0 (SMD=0.39; 95% CI - 0.21-0.57) and jitter (SMD=0.23; 95% CI - 0.02-0.45) were observed. Vocal intensity was not affected (SMD=0.09; 95% CI - 0.22-0.39) by levodopa ingestion. Data of the included studies were controversial in the auditory-perceptual analysis of voice. Conclusion Levodopa therapy modifies F0 and jitter. No changes in vocal intensity were observed in either the "on" or "off" states of levodopa therapy.

RESUMO Objetivo investigar a associação entre o uso da levodopa e as características vocais em pacientes com doença de Parkinson. Estratégia de pesquisa estudos publicados nas bases MEDLINE, LILACS e SciELO, de 1960 a dezembro de 2016. Uso dos descritores: doença de Parkinson; levodopa; L-dopa; voz; distúrbios do discurso; disfonia e disartria. Depois de analisar os títulos e os resumos, dois revisores independentes selecionaram todos os ensaios clínicos que atendiam aos critérios de seleção, selecionaram os artigos e registraram os dados em uma tabela padronizada anteriormente. Critérios de seleção ensaios publicados em inglês entre 1960 e dezembro de 2016 assuntos com diagnóstico clínico de doença de Parkinson; uso de terapia com levodopa em doses estáveis; análise acústica combinada ou não com a análise auditiva-perceptiva para avaliar os parâmetros vocais sob investigação. Análise dos dados os parâmetros vocais analisados ​​foram: frequência fundamental (F0), Jitter e intensidade vocal. As diferenças de médias padronizadas (SMD) foram calculadas com o software Metanálise Abrangente V2. Resultados 9 artigos preencheram os critérios de elegibilidade e foram selecionados, com um total de 119 indivíduos. Desses 9 artigos, 6, com 83 indivíduos, foram incluídos na metanálise. Durante a fase "on", houve uma modificação no F0 (SMD = 0,39; IC 95% 0,21-0,57) e Jitter (SMD = 0,23; IC 95% 0,02-0,45). A intensidade vocal não foi afetada (SMD = 0,09; IC 95% -0,22-0,39) pela ingestão da levodopa. Ao considerar a análise auditiva-perceptiva, os dados foram controversos entre os estudos incluídos. Conclusão a terapia com levodopa modifica F0 e Jitter. Não houve alteração na intensidade vocal nas fases "on" e "off" da terapia com levodopa.

Videofluoroscopic Predictors of Penetration-Aspiration in Parkinson's Disease Patients.

Parkinson's disease (PD) patients show a high prevalence of swallowing disorders and tracheal aspiration of food. The videofluoroscopic study of swallowing (VFSS) allows clinicians to visualize the visuoperceptual and temporal parameters associated with swallowing disorders in an attempt to predict aspiration risk. However, this subject remains understudied in PD populations. Our aim was to identify the predictors of penetration-aspiration in PD patients using the VFSS. Consecutive patients were evaluated using VFSS with different consistencies and volumes of food. A speech-language pathologist measured the type of intra-oral bolus organization, loss of bolus control, bolus location at the initiation of the pharyngeal swallow, the presence of multiple swallows, piecemeal deglutition, bolus residue in the pharyngeal recesses and temporal measures. Scores ≥3 on the penetration-aspiration scale (PAS) indicated the occurrence of penetration-aspiration. Using logistic marginal regression, we found that residue in the vallecula, residue in the upper esophageal sphincter and piecemeal deglutition were associated with penetration-aspiration (odds ratio (OR) = 4.09, 2.87 and 3.83; P = 0.0040, 0.0071 and 0.0009, respectively). Penetration/aspiration occurred only with fluids (both of thin and thick consistency), and no significant differences were observed between fluid types or food volumes. The mechanisms underlying dysphagia and penetration/aspiration in PD patients and indications for further studies are discussed.

Swallowing disorders in Parkinson's disease: impact of lingual pumping.

BACKGROUND: Lingual pumping (LP) is a repetitive, involuntary, anteroposterior movement of the tongue on the soft palate that is executed prior to transferring the food bolus to the pharynx, but we also observed LP when multiple swallows were taken. LP may be associated with rigidity and bradykinesia in patients with Parkinson's disease (PD). This phenomenon tends to be more prevalent in dysphagic PD patients, and its impact on swallowing dynamics remains poorly understood. OBJECTIVE: To evaluate how LP interferes with the oral and pharyngeal phases of the swallowing of foods of different consistencies and volumes. METHODS: We used videofluoroscopy to study the swallowing of 69 PD patients performing 10 swallows of barium mixed with foods of different consistencies and volumes. RESULTS: LP was associated with the unstable intra-oral organization of the bolus, the loss of bolus control, the pharyngeal retention of food and food entering the airway. This abnormal movement was also associated with a shorter oral transit time and was found to be more prevalent with food of thicker consistencies. CONCLUSIONS: LP is associated with swallowing incoordination and with food entering the airway. Preventive measures to minimise the pulmonary or nutritional consequences of this behaviour are necessary.

Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson's disease?

OBJECTIVE: To investigate the effect of motor swallowing exercises on swallowing dynamic, quality of life and swallowing complaints in Parkinson's disease (PD). DESIGN: A before-after trial. SETTING: University Medical Center. PARTICIPANTS: Parkinson's disease patients with dysphagia complaints. INTERVENTIONS: Motor swallowing exercises designed to increase the strength and range of motion of the mouth, larynx and pharyngeal structures, coordination between breathing and swallowing, and airway protection. Patients should perform the exercises twice a day, five days a week, for five weeks. MAIN OUTCOME MEASURE(S): The primary outcome was the difference before and after the intervention in number of swallowing videofluoroscopic events (Swallowing Score). The secondary outcomes were quality of life (QOL) and swallowing complaints. RESULTS: Fifteen patients concluded the study (10 man/5 woman; mean age 59.2 ± 9.17). The videofluoroscopic events with greater improvement were loss of bolus control (P < 0.03), piecemeal swallow (P = 0.05) and residue on the tongue (P < 0.01), valleculae (P = 0.01) and pyriform sinuses (P = 0.05). Lingual pumping and dental absence were interfering factors associated with treatment failure (beta standardized coefficient = -16.6, 26.2; P = 0.02, 0.002, respectively). The domains with greater improvements in QOL were fear (P = 0.02) and symptom frequency (P = 0.05). Regarding swallowing complaints, patients reported to have reduced mainly their difficulty in moving food in the mouth when chewing (P = 0.02). Reduction in swallowing disorders was not related with QOL improvement (cor = 0.13, [95% CI, 0.6-0.4], P = 0.63). CONCLUSIONS: Motor swallowing exercises may reduce swallowing disorders in PD patients without lingual pumping and dental absence and impact positively QOL and swallowing complaints in individuals with PD.

Domestic relations in Brazil: legacies and horizons.

Grounded in literature review and an ethnographic study, this article examines contemporary Brazilian domestic life. Relations among women (employers and maids) and between women and men are analyzed with a focus on the home as a space in which gender, race, and class inequalities are constantly reproduced. The article argues that what happens in domestic life is constitutive of wider social divisions and that the domestic is a universe integral to the national social context. A case in point is the connection between the widespread use of paid domestic labor and the naturalization of black women as subservient, complementing the pairing of whiteness and class entitlement. Another case is the buffering role of maids in the development of gender conflicts in well-off homes, thus blurring gender hierarchies at a broader scale. Locating the domestic within the recent discussion on global domestic labor, the article compares particularities of Brazilian domestic life to those elsewhere.

O grupo de reflexão como estratégia de promoção de saúde com famílias adotivas / Reflection groups as a family health promotion strategy / Grupos de reflexión como estrategia de promoción de la salud en familias

Neste trabalho pretendemos apresentar uma experiência de utilização de grupos de reflexão como estratégia para a promoção da saúde das famílias que se constituem pela via da adoção. A Vara da Infância, da Juventude e do Idoso (VIJI) da Comarca do Rio de Janeiro tem oferecido um espaço denominado “Café com Adoção”, no qual a troca de informações e de experiências vem auxiliando diversos sujeitos a trabalhar as fantasias e temores que envolvem a paternidade adotiva. Dúvidas e dificuldades surgidas desde o início do procedimento de habilitação até a chegada do filho e as etapas iniciais da interação com ele são revistas. Destacamos a importância da função de continente que exerce um grupo com as características apresentadas. Nos casos em que os participantes já haviam recebido o certificado de habilitação, mas ainda aguardavam a chegada do filho, o grupo os auxiliou a viver algo equivalente a uma gravidez psíquica, apesar da ausência da gravidez física. Verificamos que os requerentes à adoção e os pais adotivos participantes do grupo formam uma nova rede de apoio que acolhe suas inseguranças e os auxilia a elaborá-las.

In this paper we intend to present an experience of using reflection groups as a health promotion strategy among families constituted through adoption. The Child, Youth and Elderly Welfare Division (VIJI) of the District of Rio de Janeiro has offered a program called “Coffee with Adoption”, in which sharing information and experience has been helping many individuals work out their fantasies and fears involving adoptive parenting. Doubts and difficulties that emerged since the beginning of the habilitation procedure to the arrival of the child, along with early steps of the interaction are then reviewed. We give special importance to the continent function that such group accomplishes. Situations in which participants had already received the habilitation certificate, although still awaited the arrival of the child, could profit from the group’s aid and support to regard the situation as an equivalent to a psychic pregnancy, despite the lack of physical pregnancy. We verify that the adoption applicants and the adoptive parents participating in the group formed a new support net, capable of hosting their insecurities and helping in working them out.

En este trabajo pretendemos presentar una experiencia de utilización de grupos de reflexión como estrategia para la promoción de la salud que se constituyen por medio de la adopción. La Jurisdicción de la Niñez, de la Juventud y del Anciano (VIJI) de la Comarca de Rio de Janeiro ha ofrecido un espacio llamado “Café con Adopción”, en El cual el intercambio de informaciones y de experiencias está ayudando diversos sujetos a trabajaren las fantasías y temores involucrados en la paternidad adoptiva. Ahí son revisadas dudas y ansiedades que surgen desde el inicio del procedimiento de habilitación hasta la llegada del hijo y las etapas iniciales de interacción con el. Destacamos la importancia de la función de continente que ejerce un grupo con las características presentadas. En aquellos casos en que los participantes ya habían recibido su certificado de habilitación pero que todavía esperaban la llegada delhijo, el grupo les ayudó a vivir algo equivalente a un embarazo psíquico, a pesar de la ausencia del embarazo físico. Verificamos que los candidatos a la adopción y los padres adoptivos participantes del grupo conforman una nueva red de apoyo que acoge sus inseguridades y les ayuda a resolverlas.

O grupo de reflexão como estratégia de promoção de saúde com famílias adotivas / Reflection groups as a family health promotion strategy / Grupos de reflexión como estrategia de promoción de la salud en familias

Neste trabalho pretendemos apresentar uma experiência de utilização de grupos de reflexão como estratégia para a promoção da saúde das famílias que se constituem pela via da adoção. A Vara da Infância, da Juventude e do Idoso (VIJI) da Comarca do Rio de Janeiro tem oferecido um espaço denominado “Café com Adoção”, no qual a troca de informações e de experiências vem auxiliando diversos sujeitos a trabalhar as fantasias e temores que envolvem a paternidade adotiva. Dúvidas e dificuldades surgidas desde o início do procedimento de habilitação até a chegada do filho e as etapas iniciais da interação com ele são revistas. Destacamos a importância da função de continente que exerce um grupo com as características apresentadas. Nos casos em que os participantes já haviam recebido o certificado de habilitação, mas ainda aguardavam a chegada do filho, o grupo os auxiliou a viver algo equivalente a uma gravidez psíquica, apesar da ausência da gravidez física. Verificamos que os requerentes à adoção e os pais adotivos participantes do grupo formam uma nova rede de apoio que acolhe suas inseguranças e os auxilia a elaborá-las. (AU)

In this paper we intend to present an experience of using reflection groups as a health promotion strategy among families constituted through adoption. The Child, Youth and Elderly Welfare Division (VIJI) of the District of Rio de Janeiro has offered a program called “Coffee with Adoption”, in which sharing information and experience has been helping many individuals work out their fantasies and fears involving adoptive parenting. Doubts and difficulties that emerged since the beginning of the habilitation procedure to the arrival of the child, along with early steps of the interaction are then reviewed. We give special importance to the continent function that such group accomplishes. Situations in which participants had already received the habilitation certificate, although still awaited the arrival of the child, could profit from the group’s aid and support to regard the situation as an equivalent to a psychic pregnancy, despite the lack of physical pregnancy. We verify that the adoption applicants and the adoptive parents participating in the group formed a new support net, capable of hosting their insecurities and helping in working them out. (AU)

En este trabajo pretendemos presentar una experiencia de utilización de grupos de reflexión como estrategia para la promoción de la salud que se constituyen por medio de la adopción. La Jurisdicción de la Niñez, de la Juventud y del Anciano (VIJI) de la Comarca de Rio de Janeiro ha ofrecido un espacio llamado “Café con Adopción”, en El cual el intercambio de informaciones y de experiencias está ayudando diversos sujetos a trabajaren las fantasías y temores involucrados en la paternidad adoptiva. Ahí son revisadas dudas y ansiedades que surgen desde el inicio del procedimiento de habilitación hasta la llegada del hijo y las etapas iniciales de interacción con el. Destacamos la importancia de la función de continente que ejerce un grupo con las características presentadas. En aquellos casos en que los participantes ya habían recibido su certificado de habilitación pero que todavía esperaban la llegada delhijo, el grupo les ayudó a vivir algo equivalente a un embarazo psíquico, a pesar de la ausencia del embarazo físico. Verificamos que los candidatos a la adopción y los padres adoptivos participantes del grupo conforman una nueva red de apoyo que acoge sus inseguridades y les ayuda a resolverlas. (AU)

Família é muito sofrimento: um estudo de casos de devolução de crianças / Family is a great deal of suffering: a study of cases of children “returned”

O objetivo deste trabalho é discutir as motivações expressas por sujeitos que se disponibilizaram a exercer a parentalidade através da adoção, porém retornaram à Justiça com a intenção de entregar as crianças que já se encontravam sob sua guarda. Estudos sobre o tema são escassos, porém revelam as dificuldades encontradas pelos adultos ao confrontarem a criança por eles idealizada com a criança real. Após a realização de uma pesquisa documental, quando foram consultados dez processos de adoção, constatamos que, em todos eles, as crianças foram culpabilizadas pelo fracasso do projeto de adoção. As dificuldades apresentadas pelos adultos quanto a lidar com a diferença e suportar frustrações, a falta de vínculo, a incapacidade de conter a agressividade da criança e dar-lhe um sentido, destacaram-se entre as características presentes nas diversas situações analisadas.

The goal of this work is to discuss the motivations expressed by individuals who decided to adopt a child but laterreturned him/her to the Justice system. Studies on this subject are rare yet reveal the difficulties encountered by adults when confronting the idealized child with the real one. After a research based on court documents, where 10 adoption processes were consulted, we came to the conclusion that, in all of them, the children themselves were blamed for the adoption failure. In the different situations analyzed, we highlight the following characteristics: difficulties presented by the adults when dealing with difference, not being able to handle frustrations, the lack of attachment, and the incapacity to contain the child’s aggressiveness and give it a meaning.

El objetivo de este trabajo es discutir las motivaciones expresas por sujetos que se disponibilizaron a ejercer la parentalidad a través de la adopción, pero retornaron a la Justicia con la intención de entregar los niños que ya seencontraban sobre su guarda. Estudios sobre el tema son escasos, pero revelan las dificultades encontradas por los adultos al confrontaren el niño por ellos idealizado con el niño real. Después de la realización de una pesquisa documental, cuando fueron consultados diez procesos de adopción, constatamos que, en todos ellos, los niños fueronculpabilizados por el fracaso del proyecto de adopción. Las dificultades presentadas por los adultos cuanto a lidiar con la diferencia y suportar frustraciones, la falta de vínculo, la incapacidad de contener la agresividad del niño y dar-le un sentido, se destacaron entre las características presentes en las diversas situaciones analizadas.

“Família é muito sofrimento”: um estudo de casos de “devolução” de crianças / “Family is a great deal of suffering”: a study of cases of children “returned”

O objetivo deste trabalho é discutir as motivações expressas por sujeitos que se disponibilizaram a exercer a parentalidade através da adoção, porém retornaram à Justiça com a intenção de entregar as crianças que já se encontravam sob sua guarda. Estudos sobre o tema são escassos, porém revelam as dificuldades encontradas pelos adultos ao confrontarem a criança por eles idealizada com a criança real. Após a realização de uma pesquisa documental, quando foram consultados dez processos de adoção, constatamos que, em todos eles, as crianças foram culpabilizadas pelo fracasso do projeto de adoção. As dificuldades apresentadas pelos adultos quanto a lidar com a diferença e suportar frustrações, a falta de vínculo, a incapacidade de conter a agressividade da criança e dar-lhe um sentido, destacaram-se entre as características presentes nas diversas situações analisadas.(AU)

The goal of this work is to discuss the motivations expressed by individuals who decided to adopt a child but laterreturned him/her to the Justice system. Studies on this subject are rare yet reveal the difficulties encountered by adults when confronting the idealized child with the real one. After a research based on court documents, where 10 adoption processes were consulted, we came to the conclusion that, in all of them, the children themselves were blamed for the adoption failure. In the different situations analyzed, we highlight the following characteristics: difficulties presented by the adults when dealing with difference, not being able to handle frustrations, the lack of attachment, and the incapacity to contain the child’s aggressiveness and give it a meaning.(AU)

El objetivo de este trabajo es discutir las motivaciones expresas por sujetos que se disponibilizaron a ejercer la parentalidad a través de la adopción, pero retornaron a la Justicia con la intención de entregar los niños que ya seencontraban sobre su guarda. Estudios sobre el tema son escasos, pero revelan las dificultades encontradas por los adultos al confrontaren el niño por ellos idealizado con el niño real. Después de la realización de una pesquisa documental, cuando fueron consultados diez procesos de adopción, constatamos que, en todos ellos, los niños fueronculpabilizados por el fracaso del proyecto de adopción. Las dificultades presentadas por los adultos cuanto a lidiar con la diferencia y suportar frustraciones, la falta de vínculo, la incapacidad de contener la agresividad del niño y dar-le un sentido, se destacaron entre las características presentes en las diversas situaciones analizadas.(AU)

Custo médio do Módulo de Coleta de sangue total pelo método ABC / The mean cost of collection of whole blood units by the ABC method

Os procedimentos em hemoterapia são complexos e caros. Exigem processos controlados e validados, equipamentos calibrados e monitorados e insumos qualificados, validados e inspecionados antes e durante o uso. Isto acarreta, além dos gastos diretos, gastos indiretos especificamente relacionados à garantia da qualidade e da segurança transfusionais, além dos gastos indiretos usuais de qualquer produto ou serviço. Procurando avaliar com maior aproximação estes custos e buscando evitar as distorções das apropriações de custos por rateios, o presente estudo utilizou o sistema de Custeio Baseado em Atividades - ABC, para apurar o custo médio do Módulo de Coleta de sangue total no Hemocentro de Ribeirão Preto - SP, unidade sede, no primeiro semestre de 2006. O maior impacto no custo médio apurado se deveu aos custos monetários diretos, entretanto os custos indiretos não foram desprezíveis. O custo médio obtido para desempenho das atividades que compõem o Módulo de Coleta foi de R$ 35,20, que é 68,75 por cento superior ao valor pago na tabela SIA/SUS para este módulo. A metodologia desenvolvida pode ser aplicada aos outros procedimentos dos serviços de hemoterapia, permitindo a avaliação dos custos de seus processos, evitando desperdícios, aprimorando o seu funcionamento e gerando evidências objetivas que demonstrem os custos reais da hemoterapia de qualidade para as instâncias financiadoras públicas e privadas.

The procedures in hemotherapy are complex and expensive. They demand a controlled and validated process. They also require calibrated and monitored equipment and qualified and validated materials, inspected before and during use. This causes, apart from direct expenses, indirect expenses related to the guarantee of quality and transfusional safety, as well as the usual indirect costs of any product or service. The present study used the Activity-Based Costing system - ABC, to find the mean cost of collection of whole blood units in a Regional Blood Center in Ribeirão Preto, during the first semester of 2006, in order to assess these costs more carefully and to try to avoid the cost distortions due to separation of blood components. Although the indirect costs were not negligible, the major impact on the mean cost was related to direct monetary costs. The mean cost to perform the activities that compose the collection of blood units was R$ 35.20, which is 68.75 percent higher than the value paid by the Brazilian government for this unit. The developed methodology can be applied to other procedures of services in hemotherapy allowing the evaluation of process costs, avoiding waste, improving performance and generating objective evidence to demonstrate the real cost of quality hemotherapy activities for public and private fund source.