High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy.

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Peripheral arterial disease progression and ankle brachial index: a cohort study with newly diagnosed patients with type 2 diabetes.

BACKGROUND: Little is known about the evolution of peripheral arterial disease (PAD) since diagnosis and its association with glycemic and lipid control in patients with Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: Evaluate the actual criteria to start screening PAD with ankle-brachial index (ABI) in T2DM patients and assess its progression and relationship with glycemic and lipid control since diagnosis. METHODS: We performed a 3-year prospective cohort study with two groups: group 1 (978 individuals with T2DM undergoing drug treatment) and group 2 [221 newly diagnosed drug-naive (< 3 months) patients with T2DM]. PAD diagnosis was by ABI ≤ 0.90, regardless any symptoms. RESULTS: As expected, abnormal ABI prevalence was higher in group 1 vs. Group 2 (87% vs. 60%, p < 0.001). However, abnormal ABI prevalence did not differ between patients over and under 50 years in both groups. Our drug-naive group stabilizes ABI (0.9 ± 0.1 vs 0.9 ± 0.1, p = NS) and improved glycemic and lipid control during follow-up [glycated hemoglobin (HbA1c) = 8.9 ± 2.1 vs 8.4 ± 2.3%, p < 0.05; LDL = 132 ± 45 vs 113 ± 38 mg/dL, p < 0.01, respectively]. When compared, patients who evolved with normalization or maintained normal ABI levels at the end [Group A, N = 60 (42%)] with those who decreased ABI to abnormal levels (ABI basal 1.0 ± 0.1 vs final 0.85 ± 0.1, p < 0.001) [Group B, N = 26 (18%)], an improvement in HbA1c (9 ± 2 vs 8 ± 2%, p < 0.05) and a correlation between the final HbA1c with ABI (r = - 0.3, p = 0.01) was found only in the first. In addition, a correlation was found between albuminuria variation and ABI solely in group A (r = - 0.3; p < 0.05). CONCLUSION: Our study suggests that ABI should be measured at diagnosis in T2DM patients, indicating that current criteria to select patients to screen PAD with ABI must be simplified. An improvement in albuminuria and glycemic and lipid control could be related with ABI normalization in newly diagnosed T2DM drug-naive patients.

Health-related quality of life in T1DM patients after high-dose cholecalciferol supplementation: data from a pilot clinical trial.

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) impacts health-related quality of life (HRQoL). Cross-sectional studies suggest that low levels of vitamin D (VD) may impair HRQoL, however, the effect of VD supplementation on quality of life in T1DM patients has not yet been clarified. Our study evaluated the effects of high-dose VD supplementation on HRQoL in T1DM. METHODS: We performed a prospective study with 64 patients receiving cholecalciferol (4000 IU/day for patients with 25-OH-vitamin D [25(OH)D] between 30 and 60 ng/mL, and 10,000 IU/day for those with 25(OH)D below 30 ng/mL) for 12 weeks, as part of a research protocol. HRQoL was assessed with EuroQol instruments (EQ-5D and EQ-VAS). RESULTS: There was an improvement in global EQ-5D index, and analysing specifically the EQ-5D domains, we observed an improvement in mobility (1.3 ± 0.6 versus 1.1 ± 0.3, p < 0.01). Evaluating possible outcome influencing variables, we detected a reduction in albuminuria at the end of the trial, without changes in BMI, lipids, blood pressure, glycemic control and insulin doses. We found correlations between final albuminuria and the dimensions: mobility (r = 0.6; p < 0.01), personal care (r = 0.7; p < 0.01), pain and discomfort (r = 0.6; p < 0.01) and habitual activities (r = 0.6; p < 0.01), suggesting an association between albuminuria reduction and the impact of VD supplementation on HRQoL. CONCLUSION: Our data showed that high doses of cholecalciferol supplementation can improve HRQoL in patients with T1DM, and the reduction of albuminuria seems to be an important factor in this context. TRIAL REGISTRATION: (ISRCTN32601947), 03/06/2017 retrospectively registered.

High-dose Vitamin D Supplementation on Type 1 Diabetes Mellitus Patients: Is there an Improvement in Glycemic Control?

BACKGROUND: Some authors evaluated the effect of VD on hyperglycemia in T1DM, but the results remain controversial. This study aims to analyze the effects of high-dose VD supplementation on T1DM patients' glycemic levels, maintaining stable doses of insulin. METHODS: Prospective, 12-week clinical trial including 67 T1DM patients, supplemented with high doses of cholecalciferol according to participants' VD value. Patients with VD levels below 30 ng/mL received 10,000 IU/day; those with levels between 30-60 ng/mL received 4,000 IU/day. Patients who had not achieved 25(OH)D levels > 30 ng/ml or presented insulin dose variation during the study were not analyzed. RESULTS: Only 46 out of 67 patients accomplished the criteria at the end of the study. There was no general improvement in the glycemic control evaluated by HbA1c (9.4 ± 2.4 vs 9.4 ± 2.6, p=NS) after VD supplementation. However, a post-hoc analysis, based on HbA1c variation, identified patients who had HbA1c reduced at least 0.6% (group 1, N = 13 (28%)). In addition, a correlation between 25(OH)D levels with HbA1c and total insulin dose at the end of the study was observed (r = -0.3, p<0.05; r=-0.4, p<0.05, respectively), and a regression model demonstrated that 25(OH)D was independent of BMI, duration of T1DM and final total insulin dose, being capable of determining 9.2% of HbA1c final levels (Unstandardized B coefficient = -0.033 (CI 95%: -0.064 to -0.002), r2 = 0.1, p <0.05). CONCLUSION: Our data suggest that VD is not widely recommended for glycemic control. Nevertheless, specific patients might benefit from this approach.

Association Between 25(OH)Vitamin D, HbA1c and Albuminuria in Diabetes Mellitus: Data From a Population-Based Study (VIDAMAZON).

Background: The effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified. Objective: Evaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM). Patients and Methods: Cross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function. Results: Patients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 vs 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 vs 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 - 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently. Conclusion: Our study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.

Health knowledge, health behaviors and attitudes during pandemic emergencies: A systematic review.

BACKGROUND: People with good health knowledge present a conceptual and objective appropriation of general and specific health topics, increasing their probability to express health protection and prevention measures. The main objective of this study was to conduct a rapid systematic review about the effects of health knowledge on the adoption of health behaviors and attitudes in populations under pandemic emergencies. METHODS: A systematic review was performed according to PRISMA checklist and the Cochrane method for rapid systematic reviews. Studies searches were performed in APA PsycNet, Embase, Cochrane Library and PubMed Central. Studies published between January 2009 and June 2020 and whose primary results reported a measure of interaction between health knowledge, health attitudes and behaviors in population groups during pandemics were included. A review protocol was recorded in PROSPERO (CRD42020183347). RESULTS: Out of a total of 5791 studies identified in the databases, 13 met the inclusion criteria. The included studies contain a population of 26099 adults, grouped into cohorts of health workers, university students, clinical patients, and the general population. Health knowledge has an important influence on the adoption of health behaviors and attitudes in pandemic contexts. CONCLUSIONS: The consolidation of these preventive measures favors the consolidation of public rapid responses to infection outbreaks. Findings of this review indicate that health knowledge notably favors adoption of health behaviors and practices. Therefore, health knowledge based on clear and objective information would help them understand and adopt rapid responses to face a pandemic.

Association of Soy and Exclusive Breastfeeding With Central Precocious Puberty: A Case-Control Study.

Introduction: While soy is suggested as a possible risk factor, exclusive breastfeeding (EBF) has a likely protective effect in precocious puberty. Our aim was to evaluate the association between both of these variables with central precocious puberty (CPP). Methods: We performed a retrospective, case-control study. A total of 161 girls were divided into two groups: 84 patients diagnosed with CPP composed the case group and 77 patients without the diagnosis of CPP (had gone through normal onset of puberty) were the control group. Results: Our control group had a higher presence of EBF >6 months, which was an important protective factor for CPP (OR: 0.5; IC 95%: 0.3-0.9, p = 0.05) and also correlated negatively with the presence of it (r = -0.2; p < 0.05). Oppositely, the use of soy was significantly higher in the CPP group, (OR: 3.8; IC 95%: 1.5-6, p < 0.05) and positively correlating (r = 0.2; p < 0.01) with the presence of CPP. Duration of soy intake (years) correlated with bone age (r = 0.415; p < 0.05). A logistic regression was performed to evaluate the effects of EBF duration and soy on CPP. The model was significant (x² (2) = 20,715, p = <0.001) and explained 12.2% (Nagelkerke R2) of the variance, correctly classifying 62.5% of cases. EBF was associated with a reduction of likelihood of having CPP [OR = 0,187 (CI = 0.055-0,635); Wald = 7,222, p = 0.007], while soy intake increased the risk [OR = 3.505 (CI) = 1,688-7,279, Wald = 11,319, p = 0.001]. Conclusion: Our data found the use of soy was associated with CPP. Additionally, EBF was pointed as a protective factor. However, future prospective studies are needed to clarify this issue.

High-dose Cholecalciferol Supplementation Reducing Morning Blood Pressure in Normotensive DM1 Patients.

BACKGROUND: Vitamin D (VD) deficiency has been related to several endocrine metabolic and cardiovascular diseases. The effect of VD supplementation on blood pressure (BP) in patients with diabetes is controversial. OBJECTIVE: The aim of this study was to evaluate high-dose vitamin D supplementation effects on blood pressure of normotensive patients with diabetes mellitus 1 (DM1) patients by 24-hour ambulatory blood pressure monitoring (ABPM). METHODS: We performed a clinical trial including 35 DM1 normotensive patients, who received doses of 4,000 or 10,000 IU/day of cholecalciferol for 12 weeks according to previous VD levels. They underwent 24-hour ABPM, along with glycated hemoglobin, creatine, lipids profile and PCRus dosage before and after VD supplementation. RESULTS: We found an expressive reduction of systolic and diastolic morning blood pressures (117±14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in other pressoric markers. Besides, we noticed a relationship between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). CONCLUSION: Our study suggests an association between supplementation of high doses of vitamin D and the reduction of morning blood pressure in normotensive DM1 patients.

Improvement in Cardiovascular Autonomic Neuropathy After High-Dose Vitamin D Supplementation in Patients With Type 1 Diabetes.

Background: Cardiovascular autonomic neuropathy (CAN) is associated with diabetes mellitus, increasing morbidity and mortality. Some cross-sectional studies associated CAN with low 25-hydroxyvitamin D levels. The aim of our study was to evaluate the effect of high-dose vitamin D (VD) supplementation on CAN in Type 1 Diabetes Mellitus (T1DM) patients. Methods: We performed a prospective study with 23 patients diagnosed with T1DM and CAN. Subjects with VD levels <30 ng/ml received 10,000 IU/day; the ones with VD levels between 30-60 ng/ml were given 4,000 IU/day for 12 weeks. Results: There was an improvement in CAN parameters related to resting heart rate variability, such as time domain parameters [Maximum RR interval (0.77 ± 0.11 vs 0.94 ± 0.51 s, p <0.05), Mean length of regular RR intervals (0.71 ± 0.10 vs 0.76 ± 0.09 s, p <0.05) and Standard deviation of all NN intervals (0.02 ± 0.01 vs 0.03 ± 0.02 s; p <0.01)] and frequency domain parameters [Low Frequency (1.9 ± 0.5 vs 2.5 ± 0.9 s, p < 0.001), Total Power (2.5 ± 0.4 vs 2.8 ± 0.6 s, p <0.05)]. In addition, there was a correlation between absolute VD level variation and posttreatment High Frequency (%), as well as among percent variation in VD level and end-of-study Low Frequency/High Frequency ratio (r=0.6, p<0.01; r= -0.5, p<0.05, respectively). Conclusion: Our pilot study is the first to suggest a strong association between high-dose vitamin D supplementation and improved cardiovascular autonomic neuropathy in T1DM patients. It occurred without any variation in HbA1C, blood pressure levels, lipids, and insulin dose. Clinical Trial Registration: http://www.isrctn.com/ISRCTN32601947, identifier ISRCTN32601947.

Vitamin D and PTH: data from a cross-sectional study in an equatorial population.

OBJECTIVE: Investigate the prevalence of vitamin D deficiency in an equatorial population through a large-sample study. METHODS: Cross-sectional study with 30,224 healthy individuals from the North Region, in Brazil (Amazônia - state of Pará), who had 25-hydroxy-vitamin D (25(OH)D) and intact parathyroid hormone (PTH) serum levels measured by immunoassay method. Those with history of acute or chronic diseases were excluded. Abnormal levels of calcium, creatinine, glycemia and albumin were also exclusion criteria. RESULTS: 25(OH)D levels were 29.1 ± 8.2 ng/mL and values <12.7 ng/mL were equal to < -2 s.d. below average. Hypovitaminosis D was present in 10% of subjects according to the Institute of Medicine (values <20 ng/mL) and in 59%, in consonance with Endocrine Society (values 20-30 ng/mL as insufficiency and <20 ng/mL as deficiency) criteria. Individuals were divided according to four age brackets: children, adolescents, adults and elderly, and their 25(OH)D levels were: 33 ± 9; 28.5 ± 7.4; 28.3 ± 7.7; 29.3 ± 8.5 ng/mL, respectively. All groups differed in 25(OH)D, except adolescents vs adults. Regression model showed BMI, sex, living zone (urban or rural) and age as independent variables to 25(OH)D levels. Comparing subjects with vitamin D deficiency (<20 ng/mL) to those with vitamin D insufficiency (20-30 ng/mL), a difference between PTH levels in these two groups was observed (95.9 ± 24.7 pg/mL vs 44.2 ± 64.5 pg/mL; P < 0.01). Additionally, the most accurate predictive vitamin D level for subclinical hyperparathyroidism in ROC curve was 26 ng/mL. CONCLUSION: Our equatorial population showed low prevalence of vitamin D hypovitaminosis ranging with age bracket. The insufficient category by Endocrine Society was corroborated by our PTH data.

UNESCO, mulheres e biopoder no Brasil: alguns apontamentos / UNESCO, notes about women and biopower in Brazil

RESUMO O texto interroga as práticas da Organização das Nações Unidas para a Educação, a Ciência e a Cultura (UNESCO) frente às mulheres brasileiras e opera uma analítica dos discursos racistas e utilitaristas que promovem disciplina e regulações securitárias com base na educação e cultura. A preocupação com os direitos violados nos países chamados em desenvolvimento pela UNESCO, e seus designados parceiros se, de um lado, constitui um importante anteparo às violências, de outro, cria condições para práticas disciplinares e securitárias de base neoliberal e mundializada que devem ser problematizadas. As mulheres entram na agenda da UNESCO sob o ângulo da segurança ameaçada e da segurança a realizar traduzido em políticas públicas dirigidas a elas e a seus filhos.(AU)

ABSTRACT This article interrogates the practices of the United Nations Educational, Scientific and Cultural Organization (UNESCO) towards brazilian women. Elaborates the Foucault´s analytics of racists and utilitarian discourses that promote discipline and securitarian regulations through education and culture. The concern with the violated rights in developing countries named by UNESCO and its designated partners, constitutes an important bulkhead to violence. However, guidelines and practices recommended by this multilateral Organization although potencially capable of producing specific improvements in the lives of some women, update neoliberal biopolitics justified by humanitarian and universalizing principles. Women are on UNESCO's agenda from the perspective of threatened security and security, translated into public policies aimed at them and their children.(AU)

Cognitive performance of children living in endemic areas for Plasmodium vivax.

BACKGROUND: The role of repeated episodes of malaria on the cognitive development of children is a relevant issue in endemic areas since it can have a long-lasting impact on individual lifespan. The aim of the current paper was to investigate whether the history of malaria can impair the verbal and performance skills of children living in an endemic area with low transmission of Plasmodium vivax malaria. METHODS: A cross-sectional study was conducted with children living in an endemic area of P. vivax malaria in Brazilian Amazon basin. The history of episodes of malaria was used as criteria for inclusion of children in the groups. The cognitive performance was assessed by the Wechsler intelligence scale for children-III edition (WISC-III), which was applied to the participants of study by two trained psychologists. RESULTS: A total of 17 cases and 26 controls was included in the study. A significant low score of verbal quotient was found in the cases (p = 0.005), however, the performance IQ was similar in both groups (p = 0.304). The full-scale IQ was significantly lower in the cases when compared to the controls (p = 0.042). The factorials index showed significant difference only in the subtest of verbal comprehension with the lower values in the cases (p = 0.0382), compared to the controls. The perceptual organization (p = 0.363), freedom from distractability (p = 0.180) and processing speed (p = 0.132) were similar in both groups. CONCLUSIONS: Children with a history of vivax malaria has a significant impairment of verbal and full-scale quotients as well as a significant low index of verbal comprehension. These findings are likely due to the absenteeism caused by malaria and by the low parental education, which impairs an adequate response to the environmental stimulus.

O caminho trilhado por usuários de um Centro de Atenção Psicossocial do Estado do Pará: construindo itinerários na busca do cuidado / The way taken by users of a Psychosocial Care Center in Pará state: building itineraries in search of assistence / El camino recorrido por usuarios de un Centro de Atención Psicosocial del Estado de Pará: construyendo itinerarios en la búsqueda del cuidado

Este artigo buscou conhecer e compreender os caminhos percorridos pelos usuários de um Centro de Atenção Psicossocial (CAPS) do Estado do Pará na busca do cuidado. A metodologia utilizada foi de abordagem qualitativa, de cunho discursivo e etnográfico. Participaram do estudo 14 usuários cadastrados no CAPS. As entrevistas foram analisadas de acordo com as categorias que emergiram a partir dos discursos e das produções de sentidos dos entrevistados quanto aos seus itinerários terapêuticos, quais sejam: trajetória assistencial; o acesso aos serviços de saúde; religiosidade e saúde mental; usuários e a busca por cuidado quando estão em sofrimento. Os itinerários terapêuticos escolhidos pelos usuários levaram em consideração aspectos concernentes ao contexto sociocultural no qual estão inseridos, utilizando-se de recursos e estratégias ligadas ao próprio acesso aos serviços de saúde da rede formal, bem como aos recursos pertinentes à religiosidade e aos aspectos relacionados ao apoio da família e dos amigos.

This paper aimed to know and understand the paths taken by users of a Psychosocial Care Centre of Pará state. The method used was qualitative, discursive and ethnographic. A total of 14 registered users were participants in this study. Interviews were analyzed according to the categories emerged from interviewed speeches and their sense of productions about therapeutic itineraries, which were: trajectory assistance care; access to health services; religiosity and mental health; users and their search for assistance when they are in distress. The therapeutic itineraries chosen by the users took in account aspects related to sociocultural context which they were involved, using the resources and strategies related to their own access in a formal health network service, as well as the relevant resources, religiosity and support offered by family and friends.

En este artículo se buscó conocer y comprender los caminos tomados por los usuarios de un Centro de Atención Psicosocial (CAPS) del Estado de Pará, en la búsqueda de cuidado. La metodología utilizada fue el enfoque cualitativo, de naturaleza discursiva y etnográfica. Los participantes del estudio fueron 14 usuarios registrados en el CAPS. Las entrevistas fueron analizadas de acuerdo a las categorías que surgieron de los discursos y de las producciones de sentidos de los usuarios en cuanto a sus itinerarios terapéuticos, los que sean: trayectoria asistencial; el acceso a los servicios de salud; religiosidad y salud mental; usuarios y la búsqueda por cuidado cuando están en sufrimiento. Los itinerarios terapéuticos elegidos por los usuarios tuvieron en cuenta aspectos relacionados con el contexto sociocultural en el que se insertan, utilizándose recursos y estrategias inherentes al propio acceso a los servicios de salud en la red formal, así como los recursos correspondientes a la religiosidad y a los aspectos relacionados con el apoyo de amigos y familiares.

O extermínio de jovens negros pobres no Brasil: práticas biopolíticas em questão / The extermination of young poor black in Brazil: practices biopolitics in question / El exterminio de los jóvenes negros pobres en Brasil: las prácticas biopolíticas en cuestión

Este artigo versa sobre a prática de extermínio de jovens pobres e negros, com baixa escolaridade, moradores das periferias urbanas brasileiras, em uma análise da biopolítica em Foucault. O crescente e massivo genocídio desse grupo, somado ao aumento do contingente de aprisionamento dessa população, assinala que o Brasil optou por duas táticas de segurança em defesa social contra um suposto inimigo penal: cadeia e caixão. Interrogar essa realidade e colocá-la em questão é uma inquietação de quem atua com pesquisas em direitos a serem garantidos e protegidos. A crítica à militarização do cotidiano e às subjetividades baseadas no medo e na insegurança deve ser uma pauta da Psicologia, na formação, na extensão, na pesquisa e na publicação.

This article deals with the practice of extermination of poor young people and blacks, with low schooling, residents of suburbs Brazilian, in an analysis biopolitics, in Foucault. The growing and massive genocide of this group plus the increase in the quota for trapping this population notes that Brazil has opted for two tactics of security, in social defense against an alleged criminal enemy, chain and coffin Ask this reality and put it in question is a concern for anyone who works with research social rights to be guaranteed and protected. The criticism of the militarization of everyday life and the subjectivities based on fear and insecurity must be an agenda of Psychology in the areas of education and training, extension, research and publication.

En este artículo se refiere a la práctica de la exterminación de los jóvenes pobres y negros, con baja escolaridad, los residentes de los suburbios brasileños, en un análisis de la biopolítica, en Foucault. La creciente y genocidio en gran escala de este grupo y el aumento de la cuota de captura esta población observa que el Brasil ha optado por dos tácticas de seguridad, de defensa social contra un presunto delincuente enemigo, cadena y ataúd preguntar a esta realidad y se la pone en cuestión es una preocupación para cualquier persona que trabaja en la investigación que se les garanticen los derechos y la protección. Las críticas a la militarización de la vida cotidiana y las subjetividades basadas en el miedo y la inseguridad debe ser un programa de psicología en las áreas de educación y capacitación, extensión, investigación y publicación.

Uma crítica à produção do TDAH e a administração de drogas para crianças / A critique of the production ADHD and the administration of drugs to children / Una crítica de la producción TDAH y la administración de medicamentos a los niños

Resumo Este artigo tem como objetivo analisar a prática de realização de diagnósticos em seus efeitos de produção do TDAH como transtorno em crianças em período escolar e operar uma crítica aos encaminhamentos indiscriminados para psiquiatras, diante de acontecimentos que são transformados em queixa escolar e tomados como anormalidades. Entre os efeitos dessa prática muito recorrente na atualidade, está o crescimento exponencial da prescrição de drogas, tais como as anfetaminas para crianças, gerando graves problemas em suas vidas, o que deve ser alvo de uma problematização ética, política e social. Especificamente, a droga mais administrada nessa situação tem sido o metilfenidato e, no Brasil, ele tem sido amplamente vendido e utilizado nos casos avaliados como de desatenção e agitação psicomotora. Esse artigo é resultado de pesquisa de pós-graduação em psicologia em andamento e são apresentados, neste texto, resultados parciais do trabalho.

Abstract This article aims to analyze the practice of diagnostics in their effects of producing ADHD as a disorder in children in school period and operate a criticism of indiscriminate referrals to psychiatrists the events that are taken as school problems and transformed into abnormalities. Among the effects of this very common practice today, is the exponential growth of prescription drugs, such as amphetamines to children, causing severe problems in their lives, which should be the subject of an ethical, political, and social problematization. Specifically, the more drug administered in this situation has been methylphenidate and in Brazil, it has been widely sold and used in cases assessed as inattention and restlessness. This article is the result of a graduate degree in psychology research, in progress and are presented in this text, partial results of the work.

Resumen Este artículo tiene como objetivo analizar la práctica de realización de diagnósticos en sus efectos sobre la producción de TDAH como trastorno en niños en etapa escolar y operar una crítica de las referencias indiscriminadas a los psiquiatras de los acontecimientos que se toman como problemas escolares y son transformados en anomalías. Entre los efectos de esta práctica muy común hoy en día, es el crecimiento exponencial de los medicamentos con receta, como las anfetaminas a los niños, causando graves problemas en sus vidas, que deben ser objeto de una problematización ética, política y social. En concreto, más droga se administra de esta situación ha sido el metilfenidato y en Brasil, se ha vendido y utilizado en casos evaluados como la falta de atención y la inquietud. Este artículo es el resultado de un título de posgrado en investigación de la psicología, en curso y se presentan en este texto, los resultados parciales de la obra.

Práticas de cuidado em saúde mental na voz dos usuários de um Centro de Atenção Psicossocial do estado do Pará / Care practices in mental health in the voice of users from a Psychosocial Care Center of the state of Pará

RESUMO Este artigo buscou analisar como as práticas de cuidado em saúde mental são percebidas pelos usuários de um Centro de Atenção Psicossocial (Caps) do estado do Pará. A metodologia utilizada foi de abordagem qualitativa, de cunho discursivo e etnográfico. Participaram do estudo 14 usuários cadastrados no Caps. As entrevistas foram analisadas de acordo com os eixos: Processo Saúde e Doença; Itinerário Terapêutico; Práticas de Cuidado em Saúde Mental; e Usuário e Autonomia. Nos discursos, o Caps foi o local em que os usuários se sentiram mais bem cuidados. Foi observada a coexistência de práticas de cuidado que corroboram os princípios da Reforma Psiquiátrica e outras que ainda reproduzem a lógica manicomial.

ABSTRACT This paper aimed to analyze how practices of care in mental health are perceived by users of a Psychosocial Care Center (Caps) of the State of Pará. The methodology used was a qualitative approach, discursive and ethnographic. 14 registered users participated in the study in Caps. The interviews were analyzed according to themes: Health and Disease Process; Route Therapeutic; Care Practices in Mental Health; User and Autonomy. In speeches, the Caps was the site where users felt better care. It was observed the coexistence of care practices that corroborate the principles of Psychiatric Reform and others that still reproduce the asylum logic.

Relato de experiência de um atendimento em um CAPS: considerações sobre o cuidado em saúde mental / Experience report of a call on a CAPS: considerations for mental health / Relato de experiência de um atendimiento em um CAPS: consideraciones de cuidado de la salud mental

O presente artigo pretende realizar uma interlocução entre o relato de experiência de um atendimento em um CAPS vivenciado por um dos autores e algumas considerações sobre o cuidado em saúde mental. A referida experiência fomentou a realização de uma dissertação no campo da saúde mental, cujo título é Com a voz, os usuários: discursos sobre as práticas de cuidado em saúde mental em um CAPS do Estado do Pará. Nesse sentido, este artigo propõe uma reflexão acerca das questões que envolvem o cuidado em saúde mental e as práticas desempenhadas no âmbito dos serviços substitutivos, de acordo com os pressupostos da Reforma Psiquiátrica e a atual Política de Saúde Mental no Brasil. O tema do cuidado em saúde mental nos serviços substitutivos ao modelo manicomial, ainda é emergente, especialmente no que se refere às práticas de cuidado no interior desses serviços.(AU)

A dialogue between a experience report of a session on a CAPS lived by one of the authors and some considerations about mental health care is presented in this paper. That experience provided to prepare a dissertation in the field of mental health, whose title is Users with the voice: discourses about the practices of mental health care in a CAPS in the state of Pará. Accordingly, this article proposes a reflection about the issues surrounding mental health care and the practices performed within the framework of substitute services, according to the assumptions of the Psychiatric Reform and the current Mental Health Policy in Brazil. The theme of mental health care in substitutive services to manicomial model is still emerging, especially with regard to the practices of care within these services.(AU)

El presente artículo pretende realizar una interlocución entre el relato de experiencia de una atención en un CAPS vivenciado por uno de los autores, y algunas consideraciones sobre el cuidado en salud mental. Esta experiencia fomentó una disertación en el campo de la salud mental, cuyo título es con la voz, los usuarios: discursos sobre las prácticas de atención de salud mental en un CAPS del estado de Pará. En consecuencia, este artículo propone una reflexión sobre las cuestiones relacionadas con la salud mental y las prácticas realizadas en el contexto de servicios sustitutos, según las hipótesis de la Reforma Psiquiátrica y la actual política de Salud Mental en Brasil. El tema a respecto del cuidado en salud mental en los servicios que sustituyen al asilo de modelo, todavía está emergiendo, especialmente en lo relativo a las prácticas de atención dentro de estos servicios.(AU)

A integralidade e as práticas em saúde da criança: uma revisão narrativa da produção científica brasileira. / The integralidade and practices in children health: a narrative review brazilian scientific production

Objetivo: buscou-se reunir um levantamento bibliográfico em forma de revisão narrativa sobre a produção atual de artigos científicos que adotam o conceito de integralidade para analisar as práticas de saúde da criança. Método: foram pesquisados artigos científicos produzidos entre os anos de 2009 e 2013. O critério de pesquisa foi a busca virtual em sites de produção acadêmica nos últimos cinco anos, tais como o Portal de Periódicos CAPES e bases de pesquisa de periódicos nacionais (Scielo, BVS – BIREME e PEPSIC). Resultados: evidenciou-se nos trabalhos estudados que apesar dos diversos sentidos dados ao conceito de integralidade, todos corroboram com o ideal de que as crianças têm o direito de serem atendidas, adequadamente, no conjunto de suas necessidades e no dever do Estado de oferecer serviços de saúde organizados para atender a essas necessidades. Considerações finais: essas devem ser atendidas em todos os níveis de assistência, por meio de ações de promoção, proteção, recuperação da saúde e reabilitação. Por isso, os desafios para implantar e implementar ações em favor da saúde da criança são inúmeros e complexos.

Objective: in this paper we sought to gather a literature review in narrative form on the production of scientific articles in the news that embrace the concept of completeness to analyze the practices of child health. Method: scientific articles produced between the years 2009 and 2013 were surveyed . The search was a virtual pursuit of academic production sites in the last five years , such as CAPES Portal Journals and Databases Search national journals (Scielo, BVS - BIREME and PEPSIC). Results: it was evident in the studies reviewed, which despite various meanings given to the concept of completeness , all corroborate the ideal that children have the right to be adequately met in the set of needs and the state’s duty to provide health services organized to meet these needs. Final considerations: these must be met at all levels of care through health promotion, protection, recovery and rehabilitation of health. So the challenges to deploy and implement actions in favor of children’s health are numerous and complex.

A noção de paternidade no documento "situação da infância brasileira. Desenvolvimento infantil: os primeiros seis anos de vida", da UNICEF / The notion of paternity in document "brazilian state of childhood. Child development: the first six years of life" of UNICEF

O presente artigo tem por objetivo refletir sobre a paternidade no documento de domínio público, enquanto prática discursiva, intitulado "Situação da Infância Brasileira. Desenvolvimento Infantil. Os primeiros seis anos de vida.". Tal análise procederá inicialmente a partir da noção de governamentalidade em Michael Foucault e do uso dos repertórios linguísticos ancorado em Mary Jane Spink, levando-se também em consideração a subjetividade e a linguagem como um viés para compreensão dessa identidade paterna, tendo em vista que o documento expõe prescrições no âmbito do cuidado e participação do pai no desenvolvimento da criança e da família e contribui para o debate sobre as rupturas, mudanças, interrogações em torno da paternidade na contemporaneidade.(AU)

The aim of this paper is to reflect on fatherhood in the public domain document, entitled "Situation of Brazilian Children. Child Development. The first six years of life. Initially, analysis will proceed from Michel Foucault's conception of governmentality, and the use of linguistic repertoires based on Mary Jane Spink, taking into account subjectivity and language as bias for understanding this paternal identity once the document sets out requirements under the care and participation of the father in child development and family, besides contributing to the debate on the breaks, changes, questions regarding paternity nowadays.(AU)

El presente artículo tiene por objetivo reflejar acerca de la paternidad en el documento de dominio publico, como práctica discursiva, intitulada "Situación de los niños brasileños. Desarrollo infantil. Los primeros seis años de vida". Este va a empezar con la noción de governamentabilidade en Michel Foucault y el uso de los repertorios lingüísticos anclados en Mary Jane Spink, teniendo en cuenta también la subjetividad y el lenguaje como un sesgo de entender esta paternidad, teniendo en cuenta que el documento haz recetas bajo el cuidado y participación del padre en el desarrollo de los niños y de la familia y contribuye al debate acerca de las rupturas, câmbios, interrogaciones en torno a la paternidad contemporánea.(AU)

Síndrome de Down: aspectos citogenéticos, clínicos epidemiológicos / Down syndrome: cytogenetic aspects, clinical and epidemiological

Objetivo: descrever os perfis citogenético, clínico e epidemiológico dos pacientes que possuemSíndrome de Down matriculados no Hospital Universitário Bettina Ferro de Souza, período de 2002 a2011. Método: estudo transversal de 156 prontuários. Foram analisadas variáveis de identificação,sócio-demográficas, de gestação, parto e nascimento, clínicas, citogenéticas, de comorbidades, deexames, de tratamento e de seguimento multiprofissional. Utilizou-se o programa BioEstat 5.0 parafazer a análise estatística. Resultados: a maioria dos pacientes pertencia ao sexo masculino (54,49%),entre 0 a 2 anos (57,05%), com média de idade de 4 anos e procedentes da Região Metropolitana deBelém (67,95%). As alterações fenotípicas mais vistas foram: pregas epicânticas (77,56%), alteraçãoauricular (69,87%), macroglossia (50,64%), alteração nasal (46,15%) e fendas palpebrais oblíquas(45,51%). O cariótipo mostrou 90,9% de trissomia livre, 6,07% de translocação e 3,03% demosaicismo. Destacaram-se como principais antecedentes pessoais: internação hospitalar (48,71%),IVAS (44,87%), cardiopatias congênitas (42,94%) e pneumonia (33,97%). Realizou-se reabilitaçãomultiprofissional em 69,87% dos casos. Constatou-se a evolução com o desfecho ao óbito em 1,28%dos casos. Conclusões: As informações obtidas neste estudo evidenciaram a diversidade que aSíndrome de Down possui e por isso a necessidade de aprimoramento e ampliação dos serviçosmultiprofissionais ofere

Objective: to describe the cytogenetic profile, and clinical-epidemiological study of patients who haveDown syndrome enrolled in the University Hospital Bettina Ferro de Souza, from 2002 to 2011.Method: cross-sectional study of 156 medical records. Were analyzed variables of identification,socio-demographics, pregnancy, labor and birth, clinical, cytogenetic, comorbidities; examinations;and multidisciplinary rehabilitation. We used the program BioEstat 5.0 to statistical analysis. Results:most patients belonged to males (54.49%), between 0-2 years (57.05%), with a mean age of 4 yearsand resident the Metropolitan Region of Belém (67.95%). The phenotypic changes most common:epicanthal folds (77.56%), ear alteration (69.87%), large tongue (50.64%), nasal alteration (46.15%)and oblique palpebral fissures (45.51%). The karyotype showed 90.9% of free trisomy, 6.07% oftranslocation and 3.03% of mosaicism. Stood out as major personal history of hospitalization(48.71%), upper respiratory infections (44.87%), congenital heart disease (42.94%) and pneumonia(33.97%). The multidisciplinary rehabilitation occurred in 69.87% of cases. It was found developmentswith the outcome to death in 1.28% of cases. Conclusions: the informations obtained in this studyshowed the diversity that has the Down syndrome and therefore the need for improvement andexpansion of multidisciplinary services offered.