Urea induces (unexpected) formation of lamellar gel-phase in low concentration of cationic surfactants.

HYPOTHESIS: The unexpected formation of a lamellar structure with concomitant gelation in solutions containing high urea concentration (40 wt%) and relatively low amount of cationic surfactant (3 wt%), indicates that a hierarchically structured complex is formed by both molecules. EXPERIMENTS: Gels formed by combination of aqueous solutions of urea and C12TAB, C14TAB or C16TAB were prepared in different proportions and their structures at microscopic and mesoscopic levels were investigated using XRD and SAXS, respectively. The elastic and viscous moduli and yield stress of the samples were determined and correlated with the composition and structuration of the gels. The lamellar structure is reversibly thermically destroyed and this process was investigated using DSC. FINDINGS: XRD revealed that, at microscopic scale, the gels are formed through crystallization of adducts containing surfactant molecules loaded into the cavities of honeycomb-like urea assemblies. Such crystalline phase arranges itself in lamellae with interplanar distance around ∼20-30 nm, which were observed by SAXS. This hierarchical structure is independent of the chain length of the cationic surfactants. The blocks of lamellae dispersed in the continuous phase form a three-dimensional rigid particulate network structure, giving the characteristic rheological behavior of a hydrogel. DSC revealed a reversible thermal transition at around 20-25 °C, beyond which the adducts and the lamellar phase are destroyed and micelles are formed. The characteristic transition temperature is independent of the chain length of the surfactant, and thus, it is not associated with their Krafft temperatures. The structures of the gels indicate that they resemble alpha-gels formed by fatty-alcohols and surfactants, although they self-assemble by different driving forces.

The effect of gender targeting of food transfers on child nutritional status: Experimental evidence from the Bolivian Amazon.

Some research suggests women are more likely to allocate additional resources to their children than are men. This perception has influenced policies such as in-kind food transfer programs and cash transfer programs, which often target women recipients. We assess whether targeting in-kind rice transfers to female versus male adult household members has a differential impact on children's short-run nutritional status. We estimate the impacts of transfers of edible rice and rice seeds, randomly allocated to female or male adults, on three anthropometric indicators: BMI-for-age, arm-muscle area, and triceps skinfold thickness. The trial includes 481 children aged 3-11 years in a horticultural-foraging society of native Amazonians in Bolivia. On average, the gender of the transfer recipient does not influence child anthropometric dimensions, possibly due to norms of cooperation and sharing within and between households. We find limited evidence of heterogeneity in impacts. Transfers to women help children who were growth stunted at baseline to partially catch-up to their better-nourished age-sex peers and help boys (but not girls) and children in higher-income households increase their BMI-for-age. The results of this research point to the importance of considering cultural context in determining if allocating food transfers according to gender are most effective.

¿Qué venden los kioscos escolares al implementar la ley sobre composición nutricional de los alimentos y su publicidad? / What do school kiosks sell when implemented the law about food nutritional composition and advertisement?

El rápido aumento de la obesidad infantil se ha asociado al elevado consumo de alimentos procesados de alta densidad energética e insuficiente actividad física. Chile el año 2016, implementó la Ley 20.606 sobre Composición Nutricional de los Alimentos y su Publicidad, que prohíbe la publicidad de alimentos altos en calorías, grasas saturadas, azúcares y sodio para los niños menores de 14 años y la venta de estos alimentos al interior de las escuelas. El objetivo de este trabajo fue identificar los cambios en la oferta y consumo de alimentos de los kioscos escolares en escuelas públicas de Chile con la implementación de la Ley 20.606 sobre Composición Nutricional de los Alimentos y su Publicidad. Se hizo so de un estudio longitudinal. La muestra provino del estudio "Efectividad de una intervención en alimentación y actividad física orientada a controlar la obesidad en niños pertenecientes a escuelas públicas en escuelas de tres regiones del país" (estudio KIND), alcanzando 351 escolares de 8 a 14 años pertenecientes a tres escuelas municipalizadas. Para analizar la oferta en el kiosco se registraron en una base Excel todos los alimentos junto a su aporte nutricional, para el consumo de alimentos, se aplicó la encuesta utilizada en el estudio KIND y la medición del estado nutricional fue realizada por nutricionistas previamente estandarizadas. Se utilizó de la línea base la información obtenida en el estudio KIND, obtenida el año 2015 y se comparó con el año 2017 a través de Test de Mac Nemar y Test de proporciones para una muestra. Todos los análisis se realizaron con STATA 15 (Copyright 1984-2009 StataCorp). Los alimentos procesados y ultra procesados (84,8%) siguen siendo los más ofertados dentro de los kioscos en donde destacan los snacks dulces y los caramelos, manteniéndose la oferta al interior y exterior de las escuelas. Los grupos de alimentos que los niños prefieren comprar y traer desde la casa en ambos periodos analizados son los snacks dulces y las bebidas y jugos azucarados. Con la implementación de la Ley 20.606, disminuyó la variedad de alimentos ofertados altos en nutrientes críticos, sin embargo, se mantiene la oferta de alimentos ultra procesados y procesados en los kioscos escolares.

The fast growth in childhood obesity has been linked to the increased intake of high energy density processed food and poor physical activity. In 2016 in Chile the law 20.606 about Food Nutritional Composition and Advertisement, forbids the advertising of food with high calories, saturated fats, sugars, and sodium for children younger than 14 years and the sale of these food products inside schools. This work aimed to identify changes in the food supply and consumption in public school kiosks from Chile with the addition of the law 20.606 about Food Nutritional Composition and Advertisement. A longitudinal study was performed. The sample came from the study "Effectiveness of a food and physical activity intervention oriented to control obesity in children belonging to public schools from three regions of the country" (KIND study), reaching 351 students from 8 to 14 years belonging to three municipal schools. To analyze the supply at the kiosk, every food product along with its nutritional content was registered in an Excel base, for the intake of food it was used the survey from the KIND study and the nutritional state measurement was made by nutritionist standardized in advance. We used the baseline of the data obtained from the KIND study, this data was gathered in 2015 and we compared it to the one from 2017 using the Mac Nemar Test and the Test for proportions of a sample. Every analysis was made with STATA 15 (Copyright 1984-2009 StataCorp). Processed and ultra-processed food (84.8%) still is the most offered in the kiosks where the sweet snacks and candy are featured, keeping the supply at the inside and outside of schools. The foods that children prefer to buy and bring from home in both analyzed periods are the sweet snacks and sugary drinks and juices. With the addition of the law 20.606, the variety of the high critical nutrient food decreased, however, the supply of processed and ultra-processed food in school kiosks still remains.

In-kind incentives and health worker performance: Experimental evidence from El Salvador.

We experimentally evaluated the effects of in-kind team incentives on health worker performance in El Salvador, with 38 out of 75 community health teams randomly assigned to performance incentives over a 12-month period. All teams received monitoring, performance feedback and recognition for their achievements allowing us to isolate the effect of the incentive. While both treatment and control groups exhibit improvements in performance measures over time, the in-kind incentives generated significant improvements in community outreach, quality of care, timeliness of care, and utilization of maternal and child health services after 12 months. Gains were largest for teams at the bottom and top of the baseline performance distribution. We find no evidence of results being driven by changes in reporting or by shifting away effort from non-contracted outcomes. These results suggest that in-kind team incentives may be a viable alternative to monetary or individual incentives in certain contexts.

Case-contrast study about parent-infant interaction in a Brazilian sample of siblings of children with autism spectrum disorders.

Siblings of children with autism spectrum disorders (ASD) present greater susceptibility to developmental problems, in comparison with siblings of typically developing children. The greater prevalence of mental health disorders among parents of children with ASD increases younger siblings' vulnerability to emotional problems. The aim of this study is to compare the interaction between carers and babies aged 2 to 26 months (M = 11.7, SD = 6.9) who are siblings of children with ASD (ASD dyads) with the interaction of dyads of siblings of typically developing children (TD dyads). The protocol of Clinical Indicators of Risk for Child Development and the Coding Interactive Behaviour measures were used to evaluate interaction. ASD dyads presented higher scores of constriction in their interaction, P = .024, with babies presenting higher scores of withdrawal behavior, P = .003, and carers presenting higher scores of depressive mood, P = .008, when compared to TD dyads. The ASD dyads have interactive impairments more frequently than do the TD dyads.

Trasfondo: Los hermanos de niños con trastornos dentro de la gama del autismo (ASD) presentan una mayor susceptibilidad a problemas del desarrollo, en comparación con los hermanos de niños que se desarrollan de una manera típica. La mayor prevalencia de trastornos de salud mental entre padres de niños con ASD aumenta la vulnerabilidad de los hermanos más jóvenes a problemas emocionales. El objetivo de este estudio es comparar la interacción entre cuidadores y bebés de edad entre 2 y 26 meses (Media: 11.7 meses/ SD: 6.9) hermanos de niños con ASD (díadas ASD), con las interacción de díadas de hermanos de niños que se desarrollan típicamente (díadas TD). Método: Para evaluar la interacción se usó el protocolo de los Indicadores Clínicos de Riesgo para el Desarrollo del Niño y la Codificación Interactiva de Conducta. Resultados: Las díadas ASD presentaron puntuaciones más altas de constricción en su interacción (p = 0.024), con los bebés que presentaron más altas puntuaciones de conducta de despego (p = 0.003) y los cuidadores que presentaron más altas puntuaciones de estados de ánimo depresivos (p = 0.008) cuando se les comparó con las díadas TD. Conclusiones: Las díadas ASD tienen impedimentos interactivos más frecuentemente que las díadas TD.

Contexte: Les frères et sœurs d'enfants avec des troubles du spectre autistique (TSA) présentent une plus grande susceptibilité à des problèmes comportementaux, comparés aux frères et sœurs d'enfants se développant typiquement. La plus grande prévalence de troubles de santé mentale avec les parents d'enfants avec TSA augmente la vulnérabilité aux problèmes émotionnels des jeunes frères ou sœurs. Le but de cette étude est de comparer l'interaction entre les parents ou personnes prenant soin des enfants et les bébés âgés de 2 à 26 mois (Moyenne: 11, 7 mois/ DS: 6,9), frères et sœurs d'enfants avec des TSA (dyades-TSA), avec l'interaction de dyades de frères et sœurs d'enfants se développant typiquement (dyades-DT). Méthode: Le protocole d'Indicateurs Cliniques de Risque pour le Développement de l'Enfant et le Codage des Comportements Interactifs ont été utilisés pour évaluer l'interaction. Résultats: les dyades TSA ont présenté des scores plus élevés de constriction (p = 0,024) de leur interaction avec les bébés présentant des scores de comportement de retrait (p = 0,003) et les personnes prenant soin des enfants ont présenté des scores plus élevés d'humeur dépressive (p = 0,008) quand comparées aux dyades-DT. Conclusions: Les dyades-TSA ont des insuffisances interactives plus fréquemment que les dyades-DT.

Monetary and nonmonetary household consumption of health services and the role of insurance benefits: An analysis of the Mexico's National Household Income and Expenditure Survey.

OBJECTIVES: To study the monetary and nonmonetary consumption of healthcare services at household level in Mexico and the magnitude of the contribution of public programs. METHODS: By using the National Household Income and Expenditure Survey 2012, we performed a cross-sectional and observational analysis of actual household consumption of health services by insurance type (no insurance, social security, Seguro Popular (SP)). Household consumption was divided into 2 categories: consumption related to "monetary" expenditure in health care and "nonmonetary" consumption in health care by the household. Nonmonetary included self-consumption or gifts received from other households and institutional contributions such as government payments or private organization transfers. RESULTS: In SP households, monetary and nonmonetary consumption of health services represented the highest proportion of available household expenditure (11.2%) compared to uninsured (8.4%) and social security (5.9%) households. The prevalence of outpatient consultation and medicine use is the highest among the health service consumption categories regardless of insurance status. Distribution of nonmonetary versus monetary consumption of health services was pro-poor: The poorer the households, the larger the proportion of nonmonetary consumption. CONCLUSIONS: The higher probability of receiving nonmonetary resources as a component of health service consumption in SP households is likely to increase the affordability to health services and likely to reduce healthcare expenditures. Future research should focus on the type of nonmonetary consumption of health services at household level to better understand financial protection and access to health care in Mexico.

The way to a man's heart is through his stomach?: a mixed methods study on causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) is highly prevalent and has detrimental effects on the physical and mental health of women across the world. Despite emerging evidence on the impacts of cash transfers on intimate partner violence, the pathways through which reductions in violence occur remain under-explored. A randomised controlled trial of a cash and in-kind food transfer programme on the northern border of Ecuador showed that transfers reduced physical or sexual violence by 30 %. This mixed methods study aimed to understand the pathways that led to this reduction. METHODS: We conducted a mixed methods study that combined secondary analysis from a randomised controlled trial relating to the impact of a transfer programme on IPV with in-depth interviews and focus group discussions with male and female beneficiaries. A sequential analysis strategy was followed, whereby qualitative results guided the choice of variables for the quantitative analysis and qualitative insights were used to help interpret the quantitative findings. RESULTS: We found qualitative and quantitative evidence that the intervention led to reductions in IPV through three pathways operating at the couple, household and individual level: i) reduced day-to-day conflict and stress in the couple; ii) improved household well-being and happiness; and iii) increased women's decision making, self-confidence and freedom of movement. We found little evidence that any type of IPV increased as a result of the transfers. DISCUSSION: While cash and in-kind transfers can be important programmatic tools for decreasing IPV, the positive effects observed in this study seem to depend on circumstances that may not exist in all settings or programmes, such as the inclusion of a training component. Moreover, the programme built upon rather than challenged traditional gender roles by targeting women as transfer beneficiaries and framing the intervention under the umbrella of food security and nutrition - domains traditionally ascribed to women. CONCLUSIONS: Transfers destined for food consumption combined with nutrition training reduced IPV among marginalised households in northern Ecuador. Evidence suggests that these reductions were realised by decreasing stress and conflict, improving household well-being, and enhancing women's decision making, self-confidence and freedom of movement. TRIAL REGISTRATION: ClinicalTrials.gov NCT02526147 . Registered 24 August 2015.

Stickers versus wafers: The value of resource in a public goods game with children / Adesivos versus wafers: O valor do recurso em um jogo de bens públicos com crianças / Pegatinas versus obleas: El valor del recurso en un juego de bienes públicos con niños

Abstract We investigated how the type of resource, food (wafer) or non-food (sticker), age and sex influence cooperation in children. 251 children were tested in a public goods game during eight rounds in two experimental conditions: wafer or sticker condition. Wafers were all of the same kind but stickers were varied. The results indicated that 1) older children donated more stickers than younger children, but they did not differ in relation to wafer donations; and 2) sticker donations remained high along the rounds, while wafer donations decreased. We propose that different strategies may be adopted according to the quality, particularly to the diversity of the resource used, and the cost of cooperation may be overcome when it is more advantageous to wait for a future reward.

Resumo Investigamos como o tipo de recurso, alimentar (wafer) ou não-alimentar (adesivo), a idade e o sexo influenciam a cooperação em crianças. Foram testadas 251 crianças em um jogo de bens públicos durante oito rodadas, em duas condições experimentais: condições wafer ou adesivo. Os wafers eram todos iguais, mas os adesivos eram variados. Os resultados indicaram que 1) as crianças mais velhas doaram mais adesivos do que as crianças mais jovens, mas elas não diferiram em relação às doações de wafers; e 2) as doações de adesivos mantiveram-se elevadas ao longo das rodadas, enquanto as doações de wafers diminuíram. Propomos que diferentes estratégias podem ser adotadas de acordo com a qualidade, particularmente quanto à diversidade do recurso utilizado, e o custo de cooperar pode ser superado quando é mais vantajoso esperar por uma recompensa.

Resumen Investigamos como el tipo de recurso, alimentar (oblea) o no alimentar (pegatina), la edad y el género influyen en la cooperación de los niños. 251 niños fueron investigados en ocho partidos de un juego de bienes públicos, en dos condiciones experimentales: oblea o pegatina. Las obleas eran todas iguales, pero las pegatinas eran variadas. Los resultados indicaron que 1) los niños mayores donaron más pegatinas que los niños más pequeños, pero no difieren con respecto a las donaciones de obleas; y 2) las donaciones de pegatinas se mantuvieron altas durante las rondas, mientras que las donaciones de obleas disminuyeron. Proponemos que diferentes estrategias pueden ser adoptadas de acuerdo con la calidad, particularmente con respecto a la diversidad de los recursos utilizados, y el costo de la cooperación puede ser superado cuando es más ventajoso esperar por una recompensa futura mejor.

Stickers versus wafers: the value of resource in a public goods game with children / Adesivos versus wafers: o valor do recurso em um jogo de bens públicos com crianças / Pegatinas versus obleas: el valor del recurso en un juego de bienes públicos con niños

We investigated how the type of resource, food (wafer) or non-food (sticker), age and sex influence cooperation in children. 251 children were tested in a public goods game during eight rounds in two experimental conditions: wafer or sticker condition. Wafers were all of the same kind but stickers were varied. The results indicated that 1) older children donated more stickers than younger children, but they did not differ in relation to wafer donations; and 2) sticker donations remained high along the rounds, while wafer donations decreased. We propose that different strategies may be adopted according to the quality, particularly to the diversity of the resource used, and the cost of cooperation may be overcome when it is more advantageous to wait for a future reward.

Investigamos como o tipo de recurso, alimentar (wafer) ou não-alimentar (adesivo), a idade e o sexo influenciam a cooperação em crianças. Foram testadas 251 crianças em um jogo de bens públicos durante oito rodadas, em duas condições experimentais: condições wafer ou adesivo. Os wafers eram todos iguais, mas os adesivos eram variados. Os resultados indicaram que 1) as crianças mais velhas doaram mais adesivos do que as crianças mais jovens, mas elas não diferiram em relação às doações de wafers; e 2) as doações de adesivos mantiveram-se elevadas ao longo das rodadas, enquanto as doações de wafers diminuíram. Propomos que diferentes estratégias podem ser adotadas de acordo com a qualidade, particularmente quanto à diversidade do recurso utilizado, e o custo de cooperar pode ser superado quando é mais vantajoso esperar por uma recompensa.

Investigamos como el tipo de recurso, alimentar (oblea) o no alimentar (pegatina), la edad y el género influyen en la cooperación de los niños. 251 niños fueron investigados en ocho partidos de un juego de bienes públicos, en dos condiciones experimentales: oblea o pegatina. Las obleas eran todas iguales, pero las pegatinas eran variadas. Los resultados indicaron que 1) los niños mayores donaron más pegatinas que los niños más pequeños, pero no difieren con respecto a las donaciones de obleas; y 2) las donaciones de pegatinas se mantuvieron altas durante las rondas, mientras que las donaciones de obleas disminuyeron. Proponemos que diferentes estrategias pueden ser adoptadas de acuerdo con la calidad, particularmente con respecto a la diversidad de los recursos utilizados, y el costo de la cooperación puede ser superado cuando es más ventajoso esperar por una recompensa futura mejor.

O exercício da função materna em mães de filhos obesos na perspectiva da psicanálise / The exercise of the maternal function in mothers of obese children from a psychoanalytical perspective / L’exercice de la fonction maternelle chez les mères d’enfants obèses dans la perspective de la psychanalyse / El ejercicio de la función materna en madres de niños obesos en la perspectiva del psicoanálisis

A pesquisa analisou as implicações da relação mãe-bebê na obesidade, sob a perspectiva da teoria psicanalítica, com cinco mães de adolescentes obesos, em Recife-PE, entre setembro e novembro/2013. Realizadas entrevistas individuais, semiestruturadas. Apontam-se impasses no exercício da função materna, criando obstáculos à resolução do processo de alienação-separação, vivência da alternância presença-ausência e reserva do lugar do pai na promoção da lei. Destaca-se a relevância de se considerar a complexa etiologia da obesidade e do seu caráter multifatorial, o que inclui a relação mãe-bebê e suas implicações na obesidade dos filhos.(AU)

The implications of the mother-baby relationship on obesity were investigated from the point of view of the psychoanalytic theory. Semi-structured interviews were conducted with five mothers of obese adolescents in Recife-PE from September to November 2013. Deficiencies were observed in the exercise of the maternal function, creating obstacles regarding the resolution of the alienation-separation process, the experience of the presence-absence interchange, and the preservation of the father’s role in promoting the law. Results highlight the importance of taking into account the complex etiology of obesity and its multifactorial nature, which includes understanding the mother-infant relationship and its implications regarding obesity.(AU)

Notre recherche a analysé les effets de la relation mère-enfant sur l’obésité du point-de-vue de la théorie psychanalytique. Des entretiens individuels et semi-structurés ont été menés avec cinq mères d’adolescents obèses à Recife-PE de septembre à novembre 2013. Ils ont révélés des impasses dans l’exercice de la fonction maternelle et par conséquence des obstacles à la résolution du processus d’aliénation séparation, à l’expérience de l’alternance de la présence-absence et à la réservation du rôle du père en vue de la promotion de la loi. Nous soulignons l’importance de prendre en considération l’étiologie complexe de l’obésité et de son caractère multifactoriel, y compris le rapport mère-bébé et ses effets sur l’obésité des enfants.(AU)

La investigación analizó las implicaciones de la relación madre-hijo en la obesidad bajo la perspectiva de la teoría psicoanalítica, con cinco madres de adolescentes obesos, en Recife, Estado de Pernambuco (Brasil), entre septiembre y noviembre del 2013. Se llevaron a cabo encuestas individuales y semiestructuradas. Observados impases en el ejercicio de la función materna, se crearon obstáculos a la resolución del proceso de alienación-separación, a la vivencia de alternancia presencia-ausencia y a la reserva del lugar del padre en la promoción de la ley. Se destaca la importancia de considerar la compleja etiología de la obesidad y su multifactorial, incluyendo la relación madre-bebé y sus implicaciones en la obesidad de los hijos.(AU)

O exercício da função materna em mães de filhos obesos na perspectiva da psicanálise / The exercise of the maternal function in mothers of obese children from a psychoanalytical perspective / L’exercice de la fonction maternelle chez les mères d’enfants obèses dans la perspective de la psychanalyse / El ejercicio de la función materna en madres de niños obesos en la perspectiva del psicoanálisis

A pesquisa analisou as implicações da relação mãe bebê na obesidade, sob a perspectiva da teoria psicanalítica, com cinco mães de adolescentes obesos, em Recife PE, entre setembro e novembro/2013. Realizadas entrevistas individuais, semi estruturadas. Apontam-se impasses no exercício da função materna, criando obstáculos à resolução do processo de alienação separação, vivência da alternância presença ausência e reserva do lugar do pai na promoção da lei. Destaca-se a relevância de se considerar a complexa etiologia da obesidade e do seu caráter multifatorial, o que inclui a relação mãe bebê e suas implicações na obesidade dos filhos.

The implications of the mother-baby relationship on obesity were investigated from the point of view of the psychoanalytic theory. Semi-structured interviews were conducted with five mothers of obese adolescents in Recife-PE from September to November 2013. Deficiencies were observed in the exercise of the maternal function, creating obstacles regarding the resolution of the alienation-separation process, the experience of the presence-absence interchange, and the preservation of the father’s role in promoting the law. Results highlight the importance of taking into account the complex etiology of obesity and its multifactorial nature, which includes understanding the mother-infant relationship and its implications regarding obesity.

Notre recherche a analysé les effets de la relation mère-enfant sur l’obésité du point-de-vue de la théorie psychanalytique. Des entretiens individuels et semi-structurés ont été menés avec cinq mères d’adolescents obèses à Recife-PE de septembre à novembre 2013. Ils ont révélés des impasses dans l’exercice de la fonction maternelle et par conséquence des obstacles à la résolution du processus d’aliénation séparation, à l’expérience de l’alternance de la présence-absence et à la réservation du rôle du père en vue de la promotion de la loi. Nous soulignons l’importance de prendre en considération l’étiologie complexe de l’obésité et de son caractère multifactoriel, y compris le rapport mère-bébé et ses effets sur l’obésité des enfants.

La investigación analizó las implicaciones de la relación madre-hijo en la obesidad bajo la perspectiva de la teoría psicoanalítica, con cinco madres de adolescentes obesos, en Recife, Estado de Pernambuco (Brasil), entre septiembre y noviembre del 2013. Se llevaron a cabo encuestas individuales y semiestructuradas. Observados impases en el ejercicio de la función materna, se crearon obstáculos a la resolución del proceso de alienación-separación, a la vivencia de alternancia presencia-ausencia y a la reserva del lugar del padre en la promoción de la ley. Se destaca la importancia de considerar la compleja etiología de la obesidad y su multifactorial, incluyendo la relación madre-bebé y sus implicaciones en la obesidad de los hijos.

Prise en charge des dyades mère traumatisée-bébé: une contrainte à la pensée et à la pratique / Tratando mães traumatizadas e seus bebês: os desafios da teoria e a prática / Treating traumatized mothers and their children: the need for improvement / Tratando a madres traumatizadas y a sus bebés: los desafíos de la teoría a la práctica

Dans le champ de la protection de l’enfance, la prise en charge de certaines dyades mère-bébé met en difficultés les professionnels et on constate une mise en échec des suivis. L’objectif est de montrer qu’il faut penser un soin plus adapté pour ces dyades. Au travers de la présentation d’une situation clinique et de son suivi, les auteurs montrent l’impact des traumas vécus par une mère dans son pays d’origine sur le développement de son bébé né en France, et de quelles façons ces traumas contaminent également les professionnels prenant en charge la dyade. Les contre-transferts négatifs peuvent créer parfois des divergences de points de vue dans les prises en charge et mettre en échec le soin proposé aux dyades mère-bébé. Ces contre-transferts témoignent d’un “partage du traumatisme”. Ce suivi est mis en lien avec une recherche qui est menée actuellement sur les modalités de transmission du trauma mère-bébé. Cette recherche implique de nombreux chercheurs-cliniciens qui travaillent à l’analyse des interactions mère-bébé et de la dynamique triadique: mère-bébé-chercheur. L’analyse du contre-transfert du chercheur permettrait d’accéder au vécu du bébé. Le but de cette recherche est d’améliorer le soin, et d’aider au mieux les professionnels accompagnant les dyades mère-bébé.

No campo da proteção da infância, o atendimento de algumas díades mãe-bebê coloca em dificuldade os professionais de saúde, e podemos constatar o fracasso de parte desses acompanhamentos. O objetivo deste artigo é trazer contribuições para o atendimento mãe-bebê. A partir da apresentação de um caso clínico, os autores buscam evidenciar o impacto dos traumas vivenciados por mães em seu país de origem sobre o desenvolvimento do seu bebê nascido na França, país de acolhida. Mas, não apenas, pois diremos que o trauma contamina igualmente os professionais de saúde que atendem à díade mãe-bebê. A força dos laços contratransferenciais negativos podem levar a uma divergência de abordagem e contribuem para o fracasso dos atendimentos centrados na díade mãe-bebê. Esses efeitos de contratransferência dão testemunho de um “compartilhamento do trauma”. Esses atendimentos fazem parte de uma pesquisa sobre as modalidades de transmissão do trauma mãe-bebê. Nesta pesquisa, em que estão envolvidos inúmeros pesquisadores clínicos, buscamos pensar as interações mãe-bebê, a transmissão do trauma e a dinâmica mãe-bebê-pesquisador. A análise da contratransferência do pesquisador permite o acesso à instância do vivido do bebê. Nosso objetivo é de facilitar o atendimento clínico e de contribuir para a prática dos professionais que acompanham a díade mãe-bebê.

Regarding child welfare, health care professionals sometimes face difficulties when they take care of certain mother-child dyads, which may result in partial care failure. A clinical picture is used to illustrate the impacts of traumas experienced by mothers in their home countries on the development of their babies, who were born in France. However, those traumas also seem to contaminate health care professionals in charge of those dyads. The impact of negative counter transferential bonds may result in conflicts regarding approaches and result in mother-child dyad care failure. Those effects of counter-transference reveal a kind of “trauma sharing”. That type of care is part of a research that involves a large number of clinical researchers and analyzes the modes of transmission of traumas between mother and child. We focused on the mother-child interaction, trauma transmission, and the mother-baby-researcher relationship. Analyzing the researcher’s countertransference helps accessing the instance of the child’s experience. We aim to facilitate clinical care and to support professional care of those mother-child dyads.

En el campo de la protección de la infancia, la atención de ciertos dúos madre-bebé, pone en aprietos a los profesionales de la salud, y podemos constatar el fracaso en el seguimiento de parte de estos casos. El objetivo de este artículo es traer contribuciones en lo relacionado con la atención madre-bebé. Desde la presentación de una situación clínica y de su seguimiento, los autores muestran el impacto que tienen los traumas vividos por una madre en su país de origen en el desarrollo de su bebé nacido en Francia, país de acogida. Sin embargo, no solamente, una vez que diremos que estos traumas contaminan también a los profesionales de la salud que le hacen el seguimiento a estos casos. La fuerza de los lazos contratransferenciales negativos, puede inducir a una divergencia en el abordaje y contribuyen en el fracaso de la atención a los dúos madre-bebé. Estas contratransferencias dan testimonio de una “trauma compartido”. Estos seguimientos hacen parte de una investigación relacionada a la transmisión del trauma madre-bebé. Esta investigación implica a numerosos investigadores clínicos, que trabajan en el análisis de las interacciones madre-bebé y en la dinámica del trío: madre-bebé-investigador. El análisis de la contratransferencia del investigador permitiría acceder a lo vivido por el bebé. Nuestro objetivo es facilitar la atención clínica y contribuir a la práctica de los profesionales que acompañan a los dúos madre-bebé.

Dermatitis herpetiforme. Presentación de un caso / Herpes-kind dermatitis. Presentation of a case

Se describe la dermatitis herpetiforme como una dermatosis ampollar de evolución crónica que puede aparecer en cualquier edad. Se presenta con una frecuencia de 10 a 39 por cada 100.000 personas, siendo menos frecuente su aparición en niños. La dermatitis herpetiforme se caracteriza por una erupción papulovesicular acompañada de prurito intenso. Se presenta el caso de un paciente masculino de 2 años de edad con un brote de lesiones vesicoampollares de aspecto herpetiforme, de un mes de evolución. Se indica dapsona a una dosis de 2 mg/kg/día, obteniéndose una excelente respuesta al tratamiento. El interés científico del caso radica en la edad del paciente, por su escasa incidencia en edades infantiles, en el diagnóstico clínico realizado y en la respuesta inmediata al tratamiento impuesto.

We describe the herpes-kind dermatitis like a chronic blistery dermatosis that can appear at any age. Its frequency ranges from 10 to 39 per 100 000 persons, being less frequent in children. The herpes-kind dermatitis is characterized by a bullous blistery rash accompanied by an intense pruritus. We present the case of a male patient aged 2 years with an outbreak of herpes-kind vesical blistery lesions, and evolution of a month. We indicated a treatment of 2mg/kg a day dapsone, obtaining an excellent answer to the treatment. The scientific importance of the case is in the patient´s age, because of the disease´s scarce incidence in infantile ages, in the clinical diagnosis and the fast answer to the indicated treatment.

Malaria infection and the anthropological evolution / Infecção por Malária e evolução antropológica

During the evolution of the genus Homo, with regard to species habilis, erectus and sapiens, malaria infection played a key biological role, influencing the anthropological development too. Plasmodia causing malaria developed two kinds of evolution, according to a biological and philogenetical point of view. In particular, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, would have either coevolved with human mankind (coevolution), or reached human species during the most ancient phases of genus Homo evolution. On the other hand, Plasmodium falciparum has been transmitted to humans by monkeys in a more recent period, probably between the end of Mesolithic and the beginning of Neolithic age. The authors show both direct and indirect biomolecular evidences of malaria infection, detected in buried subjects, dating to the Ancient World, and brought to light in the course of archeological excavations in some relevant Mediterranean sites. In this literature review the Authors organize present scientific evidences: these confirm the malarial role in affecting the evolution of populations in Mediterranean countries. The people living in several different regions on the Mediterranean Sea sides, the cradle of western civilization, have been progressively influenced by malaria, in the course of the spread of this endemic disease during the last millennia. In addition, populations affected by endemic malaria developed cultural, dietary and behaviour adaptations, contributing to decrease the risk of disease. These habits were not probably fully conscious. Nevertheless it may be thought that both these customs and biological modifications, caused by malarial plasmodia, favoured the emergence of groups of people with a greater resistance against malaria. All these considered factors decreased demographical impact, influencing in a favourable way the general development and growth of civilization.

Durante a evolução do gênero Homo a infecção por malária exerceu papel biológico chave, influenciando até o desenvolvimento antropológico. Os Plasmódios causadores da malária desenvolveram dois tipos de evolução, segundo um ponto de vista biológico, e filogenético. Em particular, os Plasmódios vivax, malariae, e ovale poderiam ter coevoluído com a espécie humana ou ter atingido esta durante as fases mais antigas da evolução do gênero HOMO. Por outro lado, o Plasmódio falciparum teria sido transmitido aos humanos por macacos num período mais recente, provavelmente entre o fim da Idade Mesolítica e o início da Neolítica. Os Autores mostram evidências biomoleculares, tanto diretas como indiretas, de infecção por malária, observada em indivíduos enterrados, reportando ao Mundo Antigo, e trazidas à luz no decorrer de escavações arqueológicas em alguns sítios relevantes Mediterrâneos. Nesta revisão da literatura, os autores organizam evidências modernas. Confirmam o papel da malária ao afetar a evolução das populações no Mediterrâneo. As pessoas que moram nas várias regiões do Mediterrâneo foram progressivamente influenciadas pela malária, ao longo do avanço desta doença. Além disso, as populações afetadas desenvolveram adaptações culturais, alimentares, e de comportamento, contribuindo para uma redução no risco da doença. Entretanto, pode ser que ambas modificações (as biológicas e as dos hábitos) usadas pelos Plasmódios da malária, favoreceram a emergência de grupos de pessoas com maior resistência contra a malária. Todos estes fatores considerados reduziram o impacto demográfico, influenciando de uma maneira favorável o desenvolvimento em geral, e o crescimento da civilização.

Arterias Renales Múltiples / Multiple Renal Arteries

El conocimiento de las variaciones de la irrigación renal es de mucha importancia debido al incremento de transplantes renales y cirugías de reconstrucción vascular. La literatura muestra que generalmente hay una arteria renal para cada riñon, sin embargo pueden observarse variaciones de origen y de número. Presentamos dos casos de arterias renales triples izquierdas, en muestras pertenecientes a la Unidad de Anatomía de la Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca. En uno de los casos, el origen de la arteria renal R1 (superior) se efectuó a nivel de la parte inferior del origen de la arteria mesentérica superior, la que después de un trayecto de 30 mm se dividió en dos ramas menores de calibre similar, que ingresaron en el hilio renal por delante de la vena renal. La rama R2 (media) se originó 4 mm distal a la anterior, correspondiendo a una rama posterior que también ingresó en el hilio; la rama R3 (inferior) lo hizo 23 mm distal a la R2. Esta última penetró en el riñon inmediatamente por debajo de la incisura del seno renal. En el segundo caso, hay diferencias con respecto al anterior, ya que la rama R1 y la R3 penetraron en el hilio renal, en cambio la R2 tiene un trayecto descendente y penetra de forma similar al R3 del caso anterior. El conocimiento de estas arterias múltiples es necesario y es de importancia consideraR1as durante la intervenciones quirúrgicas que involucren a este órgano.

Due to increase of renal transplants and vascular reconstructions, the knowledge of variations of renal arteries is very important. The literature indicates that each kind have one artery, however sometimes there are origin and number variations. We describe in this article two cases with three arteries in the left side, found in the Anatomy Unit from Health Sciences Faculty, Universidad Católica del Maule, Talca, Chile. In one case, the origin of renal artery R1 (superior) from abdominal aorta, was to level of superior mesenteric artery origin. This R1 following a 30 mm trajectory divided in two minor branches of similar diameter and entered in the hilus passing in front of the renal vein. The origin of R2 (middle) was distal 4 mm to the R1, corresponding to a posterior branch that entered in the renal hilus and the R3 (inferior) originates distal 23 mm to the R2. This last artery entered in renal cortex, inferior to the renal sinus notch. In the second case, there were diferences with respect to the first case because R1 and R3 entered in the hilus, and, R2, with descendent course entered in renal cortex, similar to R3 of first case. The knowledge of these multiple arteries is necessary and should be kept in mind before and during surgery involving the renal region.

Caracterização dos acidentes com tratores agrícolas

Despite its importance, few researches have been carried out characterizing work accidents involving agricultural tractors. The objective of this work was to characterize the accidents with agricultural tractors, to determine more efficient ways to prevent them. A questionnaire was applied to an ample of agricultural tractor operators from the Central Region of Rio Grande do Sul State. Results showed that 39% of the agricultural tractor operators analyzed had already suffered some kind of accident. The most frequent type of serious accidents was tractor overturning which occurred in 51.71% of the cases. Slips were the most important slight accident. The most important causes of accidents were lack of knowledge about safety procedures on tractor operation (32.77%), lack of attention (32.22%) to the task carried out and inadequate equipment (22.22%). There were great differences between the causes of serious and slight accidents. Operators without adequate training, no observation of some important safety procedures and very long working day were reported in this research, collaborating to increase the occurrence of accidents. Finally, it is necessary to incorporate confort and security devices, as well as training the agricultural tractor operators, to prevent future accidents.

Em despeito à sua importância, poucas pesquisas vêm sendo executadas com o intuito de caracterizar os acidentes de trabalho com tratores agrícolas, identificando sua natureza (tipo) bem como suas causas. O objetivo deste trabalho foi caracterizar os acidentes envolvendo tratores agrícolas ocorridos na região da Depressão Central do Rio Grande do Sul e, a partir disto, delinear estratégias eficientes na sua prevenção. Para o levantamento dos dados, foi aplicado um questionário aos operadores de tratores agrícolas da região da Depressão Central do Rio Grande do Sul. Os dados demonstraram que 39% dos trabalhadores rurais entrevistados já sofreram algum tipo de acidente de trabalho com tratores agrícolas. Dentre os tipos de acidentes com tratores agrícolas detectados na pesquisa, destacam-se o capotamento, que correspondeu a 51,71% do total de acidentes graves, e os escorregões, que corresponderam a 40,82% dos acidentes leves. As principais causas dos acidentes relatados foram a falta de conhecimento a respeito das medidas de segurança na operação de tratores (32,77%), a falta de atenção (32,22%) para a tarefa executada e o equipamento inadequado (22,22%). Os acidentes graves tiveram causas diferentes comparativamente aos leves. Operadores sem treinamento adequado, a não observação de regras básicas de segurança e a longa jornada de trabalho são tendências observadas neste trabalho que ampliam os riscos de ocorrência de acidentes. A inclusão de dispositivos que tornem a máquina mais segura e confortável, bem como o treinamento dos operadores de tratores agrícolas são práticas de importância fundamental para a prevenção dos acidentes com tratores agrícolas.

Caracterização dos acidentes com tratores agrícolas

Despite its importance, few researches have been carried out characterizing work accidents involving agricultural tractors. The objective of this work was to characterize the accidents with agricultural tractors, to determine more efficient ways to prevent them. A questionnaire was applied to an ample of agricultural tractor operators from the Central Region of Rio Grande do Sul State. Results showed that 39% of the agricultural tractor operators analyzed had already suffered some kind of accident. The most frequent type of serious accidents was tractor overturning which occurred in 51.71% of the cases. Slips were the most important slight accident. The most important causes of accidents were lack of knowledge about safety procedures on tractor operation (32.77%), lack of attention (32.22%) to the task carried out and inadequate equipment (22.22%). There were great differences between the causes of serious and slight accidents. Operators without adequate training, no observation of some important safety procedures and very long working day were reported in this research, collaborating to increase the occurrence of accidents. Finally, it is necessary to incorporate confort and security devices, as well as training the agricultural tractor operators, to prevent future accidents.

Em despeito à sua importância, poucas pesquisas vêm sendo executadas com o intuito de caracterizar os acidentes de trabalho com tratores agrícolas, identificando sua natureza (tipo) bem como suas causas. O objetivo deste trabalho foi caracterizar os acidentes envolvendo tratores agrícolas ocorridos na região da Depressão Central do Rio Grande do Sul e, a partir disto, delinear estratégias eficientes na sua prevenção. Para o levantamento dos dados, foi aplicado um questionário aos operadores de tratores agrícolas da região da Depressão Central do Rio Grande do Sul. Os dados demonstraram que 39% dos trabalhadores rurais entrevistados já sofreram algum tipo de acidente de trabalho com tratores agrícolas. Dentre os tipos de acidentes com tratores agrícolas detectados na pesquisa, destacam-se o capotamento, que correspondeu a 51,71% do total de acidentes graves, e os escorregões, que corresponderam a 40,82% dos acidentes leves. As principais causas dos acidentes relatados foram a falta de conhecimento a respeito das medidas de segurança na operação de tratores (32,77%), a falta de atenção (32,22%) para a tarefa executada e o equipamento inadequado (22,22%). Os acidentes graves tiveram causas diferentes comparativamente aos leves. Operadores sem treinamento adequado, a não observação de regras básicas de segurança e a longa jornada de trabalho são tendências observadas neste trabalho que ampliam os riscos de ocorrência de acidentes. A inclusão de dispositivos que tornem a máquina mais segura e confortável, bem como o treinamento dos operadores de tratores agrícolas são práticas de importância fundamental para a prevenção dos acidentes com tratores agrícolas.