Alterations of the intestinal mucus layer correlate with dysbiosis and immune dysregulation in human Type 1 Diabetes.

BACKGROUND: In preclinical models of Type 1 Diabetes (T1D) the integrity of the gut barrier (GB) is instrumental to avoid dysregulated crosstalk between the commensal microbiota and immune cells and to prevent autoimmunity. The GB is composed of the intestinal epithelial barrier (IEB) and of the mucus layer containing mucins and antimicrobial peptides (AMPs) that are crucial to maintain immune tolerance. In preclinical models of T1D the alterations of the GB primarily affect the mucus layer. In human T1D increased gut permeability and IEB damage have been demonstrated but the integrity of the mucus layer was never assessed. METHODS: We evaluated GB integrity by measuring serological markers of IEB damage (serological levels of zonulin) and bacterial translocation such as lipopolysaccharide binding protein (LBP) and myeloid differentiation protein 2 (MD2), and mRNA expression of tight junction proteins, mucins and AMPs in intestinal tissue of T1D patients and healthy controls (HC). Simultaneously, we performed immunological profiling on intestinal tissue and 16S rRNA analysis on the mucus-associated gut microbiota (MAGM). FINDINGS: Our data show a GB damage with mucus layer alterations and reduced mRNA expression of several mucins (MUC2, MUC12, MUC13, MUC15, MUC20, MUC21) and AMPs (HD4 and HD5) in T1D patients. Mucus layer alterations correlated with reduced relative abundance of short chain fatty acids (SCFA)-producing bacteria such as Bifidobacterium dentium, Clostridium butyricum and Roseburia intestinalis that regulate mucin expression and intestinal immune homeostasis. In T1D patients we also found intestinal immune dysregulation with higher percentages of effector T cells such as T helper (Th) 1, Th17 and TNF-α+ T cells. INTERPRETATION: Our data show that mucus layer alterations are present in T1D subjects and associated with dysbiosis and immune dysregulation. FUNDING: Research Grants from the Juvenile Diabetes Foundation (Grant 1-INO-2018-640-A-N to MF and 2-SRA-2019-680-S-B to JD) and from the Italian Ministry of Health (Grant RF19-12370721 to MF).

A diet enriched in omega-3 PUFA and inulin prevents type 1 diabetes by restoring gut barrier integrity and immune homeostasis in NOD mice.

Introduction: The integrity of the gut barrier (GB) is fundamental to regulate the crosstalk between the microbiota and the immune system and to prevent inflammation and autoimmunity at the intestinal level but also in organs distal from the gut such as the pancreatic islets. In support to this idea, we recently demonstrated that breakage of GB integrity leads to activation of islet-reactive T cells and triggers autoimmune Type 1 Diabetes (T1D). In T1D patients as in the NOD mice, the spontaneous model of autoimmune diabetes, there are alterations of the GB that specifically affect structure and composition of the mucus layer; however, it is yet to be determined whether a causal link between breakage of the GB integrity and occurrence of autoimmune T1D exists. Methods: Here we restored GB integrity in the NOD mice through administration of an anti-inflammatory diet (AID- enriched in soluble fiber inulin and omega 3-PUFA) and tested the effect on T1D pathogenesis. Results: We found that the AID prevented T1D in NOD mice by restoring GB integrity with increased mucus layer thickness and higher mRNA transcripts of structural (Muc2) and immunoregulatory mucins (Muc1 and Muc3) as well as of tight junction proteins (claudin1). Restoration of GB integrity was linked to reduction of intestinal inflammation (i.e., reduced expression of IL-1ß, IL-23 and IL-17 transcripts) and expansion of regulatory T cells (FoxP3+ Treg cells and IL-10+ Tr1 cells) at the expenses of effector Th1/Th17 cells in the intestine, pancreatic lymph nodes (PLN) and intra-islet lymphocytes (IIL) of AID-fed NOD mice. Importantly, the restoration of GB integrity and immune homeostasis were associated with enhanced concentrations of anti-inflammatory metabolites of the ω3/ω6 polyunsaturated fatty acids (PUFA) and arachidonic pathways and modifications of the microbiome profile with increased relative abundance of mucus-modulating bacterial species such as Akkermansia muciniphila and Akkermansia glycaniphila. Discussion: Our data provide evidence that the restoration of GB integrity and intestinal immune homeostasis through administration of a tolerogenic AID that changed the gut microbial and metabolic profiles prevents autoimmune T1D in preclinical models.

[Memory of policies and practices in harm reduction: an interview with Fatima Machado]. / Memória das políticas e práticas em redução de danos: entrevista com Fátima Machado.

This interview addresses the trajectory of harm reduction policies and practices in Brazil, in the words of harm reducer Fatima Machado. Harm reduction emerged in the 1980s in Europe, it began in Brazil in 1989 as a strategy to prevent aids among injection drug users, and then diversified and expanded. This interview focuses on the early years of developing these innovative practices and questions their current developments. Fatima Machado was one of the precursors working in the field and in activism for harm reduction in Brazil, and one of the founders of the Brazilian Association of Harm Reducers.

A entrevista aborda a trajetória das políticas e práticas de redução de danos no Brasil por meio do depoimento da redutora de danos Fátima Machado. A perspectiva de redução de danos surgiu na Europa, na década de 1980, e no Brasil iniciou em 1989, como estratégia de prevenção à aids entre usuários de drogas injetáveis, e depois se diversificou e ampliou. A entrevista focaliza os anos iniciais de desenvolvimento dessas práticas inovadoras e problematiza seus desdobramentos atuais. Fátima Machado foi uma das precursoras no trabalho de campo e ativismo da redução de danos no Brasil e uma das fundadoras da Associação Brasileira de Redutores de Danos.

Memória das políticas e práticas em redução de danos: entrevista com Fátima Machado / Memory of policies and practices in harm reduction: an interview with Fatima Machado

Resumo A entrevista aborda a trajetória das políticas e práticas de redução de danos no Brasil por meio do depoimento da redutora de danos Fátima Machado. A perspectiva de redução de danos surgiu na Europa, na década de 1980, e no Brasil iniciou em 1989, como estratégia de prevenção à aids entre usuários de drogas injetáveis, e depois se diversificou e ampliou. A entrevista focaliza os anos iniciais de desenvolvimento dessas práticas inovadoras e problematiza seus desdobramentos atuais. Fátima Machado foi uma das precursoras no trabalho de campo e ativismo da redução de danos no Brasil e uma das fundadoras da Associação Brasileira de Redutores de Danos.

Abstract This interview addresses the trajectory of harm reduction policies and practices in Brazil, in the words of harm reducer Fatima Machado. Harm reduction emerged in the 1980s in Europe, it began in Brazil in 1989 as a strategy to prevent aids among injection drug users, and then diversified and expanded. This interview focuses on the early years of developing these innovative practices and questions their current developments. Fatima Machado was one of the precursors working in the field and in activism for harm reduction in Brazil, and one of the founders of the Brazilian Association of Harm Reducers.

Rodas de redução de danos "RD: cadê você"? / Circles of dialogue of harm reduction: "RD: where are you?"

Este artigo apresenta a experiência das Rodas de Conversa "Redução de Danos: Cadê Você?" que ocorrem desde dezembro de 2017 na cidade de Porto Alegre. Por meio das rodas de conversa reuniram-se indivíduos e coletivos visando rearticular o movimento de Redução de Danos, resultando na volta à ativa do Fórum Estadual de Redução de Danos do Rio Grande do Sul (FERD-RS), movimento social no qual participam ativistas, profissionais, estudantes e interessados no tema. Apresenta-se uma breve história desta estratégia no Rio Grande do Sul e o desmonte desta política. O objetivo das "Rodas" é reunir pessoas engajadas com a Redução de Danos como ética do cuidado, estratégia clínico-política e diretriz de trabalho, de forma a construir possibilidades de resistência e intervenção. Elegeu-se o método da Roda como ferramenta metodológica para facilitar o exercício da democracia e da cogestão, descritas e analisadas no texto a partir de intervenções realizadas no território. Discutem-se os problemas de sustentabilidade desse espaço e as estratégias de atuação política utilizadas, e ressalta-se a importância de o FERD-RS se manter como uma "trincheira" de resistência e espaço de inventividade para que a Redução de Danos siga forte e se adaptando às novas demandas e cenários das políticas públicas sobre álcool e outras drogas.

How the Interplay Between the Commensal Microbiota, Gut Barrier Integrity, and Mucosal Immunity Regulates Brain Autoimmunity.

The intestinal barrier provides the host with a strong defense line against the external environment playing also a pivotal role in the crosstalk between the gut microbiota and the immune system. Notably, increasing lines of evidence concerning autoimmune disorders such as Multiple Sclerosis (MS) report an imbalance in both intestinal microbiota composition and mucosal immunity activation, along with an alteration of gut barrier permeability, suggesting this complex network plays a crucial role in modulating the course of autoimmune responses occurring in tissues outside the gut such as the central nervous system (CNS). Here, we review current knowledge on how gut inflammation and breakage of gut barrier integrity modulates the interplay between the commensal gut microbiota and the immune system and its role in shaping brain immunity.

Loss of gut barrier integrity triggers activation of islet-reactive T cells and autoimmune diabetes.

Low-grade intestinal inflammation and alterations of gut barrier integrity are found in patients affected by extraintestinal autoimmune diseases such as type 1 diabetes (T1D), but a direct causal link between enteropathy and triggering of autoimmunity is yet to be established. Here, we found that onset of autoimmunity in preclinical models of T1D is associated with alterations of the mucus layer structure and loss of gut barrier integrity. Importantly, we showed that breakage of the gut barrier integrity in BDC2.5XNOD mice carrying a transgenic T cell receptor (TCR) specific for a beta cell autoantigen leads to activation of islet-reactive T cells within the gut mucosa and onset of T1D. The intestinal activation of islet-reactive T cells requires the presence of gut microbiota and is abolished when mice are depleted of endogenous commensal microbiota by antibiotic treatment. Our results indicate that loss of gut barrier continuity can lead to activation of islet-specific T cells within the intestinal mucosa and to autoimmune diabetes and provide a strong rationale to design innovative therapeutic interventions in "at-risk" individuals aimed at restoring gut barrier integrity to prevent T1D occurrence.

Hoje eu vou ser artista! Saúde e cidadania em um cenário de internação para tratamento da tuberculose / Today I'm going to be an artist! Health and citizenship in tuberculosis treatment in a hospital setting / ¡Hoy voy a ser artista! Salud y ciudadanía en un escenario de hospitalización para tratamiento de la tuberculosis

O artigo, de natureza descritiva e reflexiva, teve como objetivo apresentar uma experiência de cuidado produzida na intersecção entre saúde, educação popular e atividades artísticas junto com pessoas internadas para tratamento da tuberculose. Resgataram-se, para a análise, as atividades ocorridas entre junho e dezembro de 2014, que foram registradas em diário de campo e em fotos. Conceitos que sustentam o quadro teórico da Vulnerabilidade e Direitos Humanos e da Educação Popular em Saúde foram alinhados para conduzir as reflexões suscitadas com as experiências. Os resultados remetem ao engajamento cidadão dos pacientes no seu cuidado e à conscientização dessas pessoas sobre seu lugar na sociedade. Concluiu-se que, em contextos de extrema vulnerabilidade psicossocial, mesmo em âmbito hospitalar, é possível e desejável a ampliação do cuidado às pessoas com tuberculose com vistas à promoção da saúde.(AU)

This article presents a care experience that occurred at the intersection of health, popular education, and arts activities developed with patients admitted to hospital for tuberculosis treatment. It focuses on activities that took place between June and December 2014 registered in a field diary and photographs. A theoretical framework based on vulnerability and human rights and the concepts of popular education was used to guide reflection. The findings reveal that patients are engaged in their care and an awareness of their place in society. It is concluded that in contexts of extreme psychosocial vulnerability, it is possible and desirable to broaden tuberculosis treatment to include health promotion, even in hospital settings.(AU)

El artículo, de naturaleza descriptiva y reflexiva, tuvo el objetivo de presentar una experiencia de cuidado producida en la intersección entre salud, educación popular y actividades artísticas con personas ingresadas para tratamiento de la tuberculosis. Para el análisis se rescataron las actividades realizadas entre junio y diciembre de 2014 que se registraron en un diario de campo y en fotos. Se alinearon conceptos que sostienen el cuadro teórico de la "Vulnerabilidad y Derechos Humanos y de la Educación Popular en Salud" para conducir las reflexiones suscitadas con las experiencias. Los resultados remiten al compromiso ciudadano de los pacientes en su cuidado y a la toma de conciencia de esas personas sobre su lugar en la sociedad. Se concluyó que, en contextos de extremada vulnerabilidad psicosocial, incluso en ámbito hospitalario, es posible y deseable la ampliación del cuidado a las personas con tuberculosis con el objetivo de promoción de la salud.(AU)

Tools, strategies and qualitative approach in relation to suicidal attempts and ideation in the elderly.

The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogotá, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.

Is it possible to overcome suicidal ideation and suicide attempts? A study of the elderly.

This study presents a qualitative analysis of how older people who had attempted suicide began to overcome the desire and the urge to take their own life. This article is based on a survey of 87 Brazilian men and women aged 60 and over, living in different regions of Brazil, who have demonstrated suicidal behaviour; twenty of whom gave important information about their coping strategies. The analysis in this article only refers to the aforementioned twenty participants. All the participants were heard through semi-structured interviews, which included questions about the process of overcoming suicidal ideation and suicide attempts. The central focus of the analysis - overcoming suicidal ideation and suicide attempts - was based on the following concepts: coping strategies, autonomy, and emotional balance. Irrespective of the gender of the respondents, five centers of meaning emerged from the discourses of the elderly, which highlighted the effectiveness of the following factors: religiosity and religious practices; social and family support; the support of health services; contact with pets; and the recovery of the autonomy to manage their own lives. This study can help to support the primary and secondary prevention of suicidal behavior in older people.

Convergence and Non-Convergence: stories of elderly who have attempted suicide and the Integrated Care System in Porto Alegre/RS, Brazil.

This article is the product of research undertaken in the city of Porto Alegre, in the Brazilian state of Rio Grande do Sul. The goal is to bring to light and discuss a little known phenomenon - attempted suicide by the elderly. Under-reporting of suicide attempts among this population makes it difficult to place this serious public health problem on the political agenda. As part of this study, we interviewed not only elderly persons who had attempted suicide, but also their family members and mental health and emergency and urgent service professionals. These interviews took place during the course of 2014. From a textual discourse analysis of the various reports, there emerged a category we will call Convergence and Non-Convergence, which deals with the relationship between the elderly population's need for care and the healthcare model in use. This study uses three short stories of individuals to question the biomedical model of serving risk situations, stressing the concept of an Expanded Clinic to provide integrated healthcare. This concept focuses on the different types of care and the uniqueness of each user, which often the biomedical model neglects. This study also highlights the need to develop a line of care for the elderly, with investments in continued education about active aging and care in times of crises, articulating a cross-sectorial network.

É possível superar ideações e tentativas de suicídio? Um estudo sobre idosos / Is it possible to overcome suicidal ideation and suicide attempts? A study of the elderly

Este estudo apresenta uma análise qualitativa sobre como idosos que tentaram suicídio passaram a superar o desejo e o impulso de tirar a própria vida. Faz parte de uma pesquisa com 87 homens e mulheres brasileiros de 60 anos ou mais, residentes em várias regiões do país e com comportamento suicida, dos quais 20 deram pistas importantes sobre suas estratégias de enfrentamento (coping). A análise aqui realizada se refere apenas a esses últimos. Todos foram ouvidos por meio de entrevistas semiestruturadas, que incluíam em seu escopo perguntas sobre o processo de superação das ideações e tentativas. O foco central da análise – superação – se apoiou nos seguintes conceitos: estratégias de enfrentamento (coping), autonomia e equilíbrio emocional. E da fala dos idosos emergiram cinco núcleos de sentido que ressaltam a efetividade dos seguintes elementos, independentemente do sexo dos entrevistados: religiosidade e práticas religiosas; apoio social e familiar; suporte dos serviços de saúde; contato com animais de estimação; e retomada da autonomia para gerir a própria vida. Este estudo pode subsidiar a prevenção primária e secundária dos comportamentos suicidas em pessoas idosas.

This study presents a qualitative analysis of how older people who had attempted suicide began to overcome the desire and the urge to take their own life. This article is based on a survey of 87 Brazilian men and women aged 60 and over, living in different regions of Brazil, who have demonstrated suicidal behaviour; twenty of whom gave important information about their coping strategies. The analysis in this article only refers to the aforementioned twenty participants. All the participants were heard through semi-structured interviews, which included questions about the process of overcoming suicidal ideation and suicide attempts. The central focus of the analysis - overcoming suicidal ideation and suicide attempts - was based on the following concepts: coping strategies, autonomy, and emotional balance. Irrespective of the gender of the respondents, five centers of meaning emerged from the discourses of the elderly, which highlighted the effectiveness of the following factors: religiosity and religious practices; social and family support; the support of health services; contact with pets; and the recovery of the autonomy to manage their own lives. This study can help to support the primary and secondary prevention of suicidal behavior in older people.

Encontros ou Desencontros: histórias de idosos que tentaram suicídio e a Rede de Atenção Integral em Porto Alegre/RS, Brasil / Convergence and Non-Convergence: stories of elderly who have attempted suicide and the Integrated Care System in Porto Alegre/RS, Brazil

Este artigo, fruto do trabalho de pesquisa realizado na cidade de Porto Alegre/RS, visa colocar em discussão um fenômeno, pouco conhecido, que é a tentativa de suicídio em idosos. A subnotificação das tentativas nessa população tem dificultado a inserção desse grave problema de saúde pública na agenda política. Neste estudo, foram entrevistados não só idosos que atentaram contra a própria vida como os seus familiares e profissionais vinculados a serviços de emergência e de urgência em geral e em saúde mental, no ano de 2014. A análise textual discursiva permitiu identificar, nos diferentes relatos, a emergência da categoria intitulada encontros e desencontros, que aborda a relação entre as necessidades de cuidado dos idosos e o modelo de atenção em saúde. O estudo, por meio de três breves histórias, questiona o modelo biomédico quanto ao atendimento a situações de risco e enfatiza, para a conquista da atenção integral em saúde, a concepção da Clínica Ampliada. Essa concepção privilegia, nas diferentes formas de cuidado, a singularidade do usuário que tem sido, muitas vezes, negligenciada no modelo biomédico. O estudo também destaca a necessidade da construção de uma linha de cuidado para a população idosa, bem como investimentos em educação permanente sobre o tema do envelhecimento ativo e do acolhimento na crise, sob a perspectiva da articulação da rede intersetorial.

This article is the product of research undertaken in the city of Porto Alegre, in the Brazilian state of Rio Grande do Sul. The goal is to bring to light and discuss a little known phenomenon - attempted suicide by the elderly. Under-reporting of suicide attempts among this population makes it difficult to place this serious public health problem on the political agenda. As part of this study, we interviewed not only elderly persons who had attempted suicide, but also their family members and mental health and emergency and urgent service professionals. These interviews took place during the course of 2014. From a textual discourse analysis of the various reports, there emerged a category we will call Convergence and Non-Convergence, which deals with the relationship between the elderly population's need for care and the healthcare model in use. This study uses three short stories of individuals to question the biomedical model of serving risk situations, stressing the concept of an Expanded Clinic to provide integrated healthcare. This concept focuses on the different types of care and the uniqueness of each user, which often the biomedical model neglects. This study also highlights the need to develop a line of care for the elderly, with investments in continued education about active aging and care in times of crises, articulating a cross-sectorial network.

Instrumentos, estratégias e método de abordagem qualitativa sobre tentativas e ideações suicidas de pessoas idosas / Tools, strategies and qualitative approach in relation to suicidal attempts and ideation in the elderly

O artigo analisa a qualidade e a consistência de um roteiro de entrevista compreensiva, adaptado para o estudo da tentativa de suicídio e sua ideação entre pessoas idosas e apresenta o método utilizado na aplicação desse instrumento. O objetivo é demonstrar como o uso da entrevista semiestruturada e sua forma de organização e análise de dados foram testados e aperfeiçoados por uma rede de pesquisadores de doze universidades ou centros de pesquisa do Brasil, Uruguai e Colômbia. O método envolveu a aplicação do instrumento em que se socializou um manual de instruções sobre a coleta, sistematização e análise de dados. A metodologia foi aplicada em 67 entrevistas com idosos na faixa de 60 anos ou mais e em 34 entrevistas com profissionais da saúde em treze municípios brasileiros, em Montevidéu e Bogotá, permitindo a verificação da consistência do instrumento usado e a aplicabilidade do método, durante o processo e ao final. O roteiro aperfeiçoado e as instruções para replicá-lo e analisá-lo são aqui apresentados. Os resultados apontam a adequação e a credibilidade dessa abordagem metodológica testada e qualificada de modo interdisciplinar e interinstitucional.

The article analyses the quality and consistency of a comprehensive interview guide, adapted to study attempted suicide and its ideation among the elderly, and imparts the method followed in applying this tool. The objective is to show how the use of a semi-structured interview and the organization and data analysis set-up were tested and perfected by a network of researchers from twelve universities or research centers in Brazil, Uruguay and Colombia. The method involved application and evaluation of the tool and joint production of an instruction manual on data collection, systematization and analysis. The methodology was followed in 67 interviews with elderly people of 60 or older and in 34 interviews with health professionals in thirteen Brazilian municipalities and in Montevideo and Bogotá, allowing the consistency of the tool and the applicability of the method to be checked, during the process and at the end. The enhanced guide and the instructions for reproducing it are presented herein. The results indicate the suitability and credibility of this methodological approach, tested and certified in interdisciplinary and interinstitutional terms.

Oficinas de história de vida: uma construção metodológica no enlace entre psicanálise e saúde coletiva / Talleres de historia de vida: construcción de un vínculo metodológico entre psicoanálisis y salud colectiva / Workshops history of life: a methodological construction of the link between psychoanalysis and public health

O objetivo deste artigo é apresentar a História de Vida como metodologia modificada para utilização em grupo. Tal ferramenta foi usada na pesquisa A construção identitária na adolescência em contextos violentos na perspectiva da Clínica em Saúde Mental, financiada pelo Edital 033/2008 do CNPq e desenvolvida em 2009 e 2010. Analisamos as potencialidades da História de Vida, proposta como dispositivo grupal, possibilitador de narrativas coletivas e ficcionais, compartilhadas e testemunhadas pelo grupo. O campo teórico do presente trabalho aproxima a Psicanálise da Saúde Coletiva. Visa, também, à construção de ferramentas clínicas e de alternativas singulares e coletivas de expressão psicossocial possíveis de serem utilizadas para além do campo da pesquisa, na clínica, na assistência social, na interface da saúde-justiça- direitos humanos voltadas aos adolescentes atendidos em serviços públicos.(AU)

En este artículo se presenta una versión adaptada del método de historia de vida, modificado para el trabajo grupal en talleres. Esta herramienta se utilizó en la investigación "La construcción de la identidad en la adolescencia en contextos violentos desde la perspectiva de la Clínica de Salud Mental", financiado por el CNPq - llamada 033/2008 y fue desarrollada entre 2009 y 2010. Fue analizado el potencial de la historia de vida como dispositivo grupal que permite las construcciones narrativas colectivas y de ficción, y que sean compartidas por el grupo. Nuestro campo teórico acerca Psicoanálisis y Salud Pública. También tiene como objetivo la construcción de herramientas clínicas y alternativas singulares para la expresión psicosocial. Esta construcción se puede utilizar más allá del campo de la investigación, la asistencia clínica, social, interfaz orientado a la salud-justicia- derechos humanos de los adolescentes asistidos en servicios públicos.(AU)

This article presents an adapted version of the life-story method, modified for workshops. This tool was used at the research "The identity construction in adolescence at violent contexts from the perspective of Clinical Mental Health", funded by CNPq - Call 033/2008 developed between 2009 and 2010. We analyzed the life-history potential as device group, that allow collective and fictional narratives, shared and witnessed by the group. Our theoretical field approaches Psychoanalysis and Public Health. It also aims to build clinical tools and singular alternative for psychosocial expression. This construction can be used beyond the field of research, clinical, social assistance, health-oriented interface justice- human rights to adolescents from public services.(AU)

Oficinas de história de vida: uma construção metodológica no enlace entre psicanálise e saúde coletiva / Talleres de historia de vida: construcción de un vínculo metodológico entre psicoanálisis y salud colectiva / Workshops history of life: a methodological construction of the link between psychoanalysis and public health

O objetivo deste artigo é apresentar a História de Vida como metodologia modificada para utilização em grupo. Tal ferramenta foi usada na pesquisa A construção identitária na adolescência em contextos violentos na perspectiva da Clínica em Saúde Mental, financiada pelo Edital 033/2008 do CNPq e desenvolvida em 2009 e 2010. Analisamos as potencialidades da História de Vida, proposta como dispositivo grupal, possibilitador de narrativas coletivas e ficcionais, compartilhadas e testemunhadas pelo grupo. O campo teórico do presente trabalho aproxima a Psicanálise da Saúde Coletiva. Visa, também, à construção de ferramentas clínicas e de alternativas singulares e coletivas de expressão psicossocial possíveis de serem utilizadas para além do campo da pesquisa, na clínica, na assistência social, na interface da saúde-justiça- direitos humanos voltadas aos adolescentes atendidos em serviços públicos...

En este artículo se presenta una versión adaptada del método de historia de vida, modificado para el trabajo grupal en talleres. Esta herramienta se utilizó en la investigación "La construcción de la identidad en la adolescencia en contextos violentos desde la perspectiva de la Clínica de Salud Mental", financiado por el CNPq - llamada 033/2008 y fue desarrollada entre 2009 y 2010. Fue analizado el potencial de la historia de vida como dispositivo grupal que permite las construcciones narrativas colectivas y de ficción, y que sean compartidas por el grupo. Nuestro campo teórico acerca Psicoanálisis y Salud Pública. También tiene como objetivo la construcción de herramientas clínicas y alternativas singulares para la expresión psicosocial. Esta construcción se puede utilizar más allá del campo de la investigación, la asistencia clínica, social, interfaz orientado a la salud-justicia- derechos humanos de los adolescentes asistidos en servicios públicos...

This article presents an adapted version of the life-story method, modified for workshops. This tool was used at the research "The identity construction in adolescence at violent contexts from the perspective of Clinical Mental Health", funded by CNPq - Call 033/2008 developed between 2009 and 2010. We analyzed the life-history potential as device group, that allow collective and fictional narratives, shared and witnessed by the group. Our theoretical field approaches Psychoanalysis and Public Health. It also aims to build clinical tools and singular alternative for psychosocial expression. This construction can be used beyond the field of research, clinical, social assistance, health-oriented interface justice- human rights to adolescents from public services...

[Suicide Prevention Program: case study in a municipality in the south of Brazil]. / Programa de Prevenção ao Suicídio: estudo de caso em um município do sul do Brasil.

This article focuses on the theme of suicide prevention based on analysis of a work in progress. A case study of the Program for Promotion of Life and Suicide Prevention of Candelária in the State of Rio Grande do Sul was conducted. It is a Brazilian municipality that has high suicide mortality rates in the general population and among the elderly. The scope of this paper is to present a experience that has proved successful and is based on a local initiative. The data presented here result from participant observation, interviews with the team carrying out the work, discussion groups and document analysis. The following categories were used: line of care, management and evaluation process. The results of intervention show that suicide rates declined from 5 deaths per year (21/100,000 inhabitants) between 1996 and 2000 to 3.6 deaths per year (12/100,000 inhabitants) between 2007 and 2009. The study establishes a dialogue with the experiences of others locations and provides contributions to prevention programs that can be set up in Brazil.

[Psychological and psychosocial autopsy on suicide among the elderly: a methodological approach]. / Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica.

The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.

Programa de Prevenção ao Suicídio: estudo de caso em um município do sul do Brasil / Suicide Prevention Program: case study in a municipality in the south of Brazil

Este artigo está focado no tema da prevenção do suicídio a partir da análise de um trabalho em desenvolvimento. Foi realizado um estudo de caso do Programa de Promoção à Vida e Prevenção ao Suicídio de Candelária (RS), um município brasileiro que apresenta altos coeficientes de mortalidade por suicídio na população geral e de idosos. O objetivo deste texto é analisar uma experiência que vem obtendo êxito e tem a base numa iniciativa local. Os dados aqui apresentados resultam de observação participante, de entrevistas com a equipe que conduz o trabalho, dos grupos de discussão e da análise documental. Foram utilizadas as seguintes categorias: linha de cuidado, gestão e processo avaliativo. Os resultados da intervenção mostram que as taxas de suicídio decresceram de 5 óbitos/ano (21/100 mil habitantes) no período 1996-2000 para 3,6 óbitos/ano (12/100 mil) em 2007-2009. O estudo estabelece um diálogo com experiências de outros locais e traz contribuições para programas de prevenção que possam ser organizados no país.

This article focuses on the theme of suicide prevention based on analysis of a work in progress. A case study of the Program for Promotion of Life and Suicide Prevention of Candelária in the State of Rio Grande do Sul was conducted. It is a Brazilian municipality that has high suicide mortality rates in the general population and among the elderly. The scope of this paper is to present a experience that has proved successful and is based on a local initiative. The data presented here result from participant observation, interviews with the team carrying out the work, discussion groups and document analysis. The following categories were used: line of care, management and evaluation process. The results of intervention show that suicide rates declined from 5 deaths per year (21/100,000 inhabitants) between 1996 and 2000 to 3.6 deaths per year (12/100,000 inhabitants) between 2007 and 2009. The study establishes a dialogue with the experiences of others locations and provides contributions to prevention programs that can be set up in Brazil.

Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica / Psychological and psychosocial autopsy on suicide among the elderly: a methodological approach

O artigo analisa a qualidade e a consistência de um roteiro de entrevista semiestruturada, adaptado para o estudo do suicídio de pessoas idosas e apresenta o método das autópsias psicossociais que resultou da aplicação desse instrumento. O objetivo é demonstrar como o uso da entrevista em profundidade e sua forma de organização e análise de dados foram testados e aperfeiçoados por uma rede de pesquisadores de vários centros de pesquisa do Brasil. O método envolveu a aplicação do instrumento em que se socializou um manual de instruções sobre a coleta, sistematização e análise de dados. A metodologia foi aplicada no estudo de 51 casos de idosos que faleceram por suicídio em dez municípios brasileiros, e permitiu a verificação da consistência do instrumento usado e a aplicabilidade do seu método, durante o processo e ao final, por meio de uma avaliação em rede. O roteiro aperfeiçoado e as instruções para replicá-lo e analisá-lo são aqui apresentados. Os resultados apontam o rigor e a credibilidade dessa abordagem metodológica testada e qualificada de um modo interdisciplinar e interinstitucional.

The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.