Internamiento involuntario vs. Retención ilegal en pacientes contrastorno mental grave / Involuntary internment vs. Illegal retention in patients with serious mental disorder

Aunque una buena actitud hacia la terapia y el cumplimiento de la misma son claves para el éxito del tratamiento, en ciertas situaciones el uso de medidas coercitivas en personas con trastornos mentales es la única forma de prevenir daños graves al paciente y a otras personas. La decisión de utilizar estas medidas, como el internamiento involuntario, es un desafío para los médicos, ya que tienen que lidiar no solo con la voluntad del paciente y de sus familiares, que se encuentran en una situación emocional desbordada, sino también con el conocimiento de la normativa vigente, especialmente complejas. Para proteger los derechos del paciente en estas situaciones difíciles y del personal clínico, es esencial que el mismo conozca los límites de su actuación en el marco del procedimiento legal. Por ello, se necesitan más estudios en la materia, que ofrezcan conclusiones contrastadas con respecto a las diferencias entre el internamiento involuntario y la retención ilegal.(AU)

Even though a good attitude towards therapy and adherence are key to an effective treatment, in certain circumstances the use of coercive actions in people with mental disorders is the only way to prevent serious harm to the patient and to others. The choice to use coercive measures, such as involuntary internment, is a challenge for doctors, since not only do they have to deal with the patient and their relatives who are in a highly emotional situation, but there are also complex legal regulations. To defend the rights of patients in these difficult situations, and to avoid legal consequences for clinical staff due to illegal acts, it is essential that staff are familiar with all of the relevant legal rules and procedures. Further studies are warranted to obtain clear conclusions regarding differences between involuntary internment and illegal retention.(AU)

Mental health professionals' attitudes towards mental competency and involuntary commitment in anorexia nervosa: Construction, validation and results of the ACINOVAN questionnaire.

INTRODUCTION: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision can be influenced by the individual attitudes of the physician. OBJECTIVE: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. METHODS: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. RESULTS: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of competence and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Support prior to involuntary interventions was significantly related to the pro-intervention and absence of capacity factors, and training in bioethics to chronicity. CONCLUSIONS: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Actitudes de los profesionales de la salud mental ante la capacidad y el internamiento no voluntario en anorexia nerviosa: construcción, validación y resultados del cuestionario ACINOVAN / Mental Health Professionals' Attitudes Towards Mental Competency and Involuntary Commitment in Anorexia Nervosa: Construction, Validation and Results of the Acinovan Questionnaire

RESUMEN Introducción: La anorexia nerviosa es un trastorno grave que causa tasas elevadas de morbilidad y mortalidad. La aplicación de una intervención no voluntaria solo es legalmente admisible si el paciente no es competente. Sin embargo, la evaluación de su capacidad puede ser extremadamente compleja. Ello conlleva que la decisión final pueda verse influida por las actitudes individuales del facultativo. Objetivo: Crear y validar empíricamente un cuestionario en español que permita medir la actitud hacia la capacidad y el internamiento no voluntario y comparar entre grupos categóricos. Métodos: Formaron la muestra 338 profesionales de salud mental. Los ítems fueron validados por grupos de expertos. Se realizaron un análisis factorial exploratorio y comparaciones grupales. Resultados: Se obtuvo un modelo de 13 ítems formado por 3 factores: prointervención, ausencia de capacidad y cronicidad. Los profesionales tienden a creer en la ausencia de capacidad y la necesidad de la intervención no voluntaria, así como en la idoneidad diferencial en virtud de la cronicidad. El respaldo previo a intervenciones involuntarias se relacionó significativamente con los factores prointervención y ausencia de capacidad y la formación en bioética, con la cronicidad. Conclusiones: El instrumento resultante es válido y fiable. Puede ser útil a profesionales, pacientes y sociedad.

ABSTRACT Introduction: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. Objective: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. Methods: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. Results: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. Conclusions: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Visibilizar indivíduos, ocultar instituições: uma análise documental de categorias governamentais para abordar o fenômeno do confinamento no Brasil / Making individuals visible, hiding institutions: a document analysis of government categories to address the phenomenon of confinement in Brazil / Visibilizar a los individuos, esconder las instituciones: un análisis documental de las categorías gubernamentales para abordar el fenómeno del encierro carcelario en el Brasil

Objetivo: descrever e analisar categorias para se referir a pessoas e estabelecimentos adotadas nos setores saúde e justiça do Poder Executivo Federal, acentuando assim a dimensão política do fenômeno do confinamento no Brasil. Metodologia: desenvolvemos uma perspectiva panorâmica dos resultados obtidos, destacando o número e a frequência dessas categorias. Nossa análise documental focalizou cartilhas e outros materiais educativos, identificados e caracterizados após consulta a quatro websites. Resultados: reunimos 147 documentos, a maioria deles com a finalidade de suscitar engajamento social e a minoria para definir normas. No setor justiça, localizamos 412 registros de expressões para se referir a populações e 274 para se referir a estabelecimentos, bem como 619 e 390 no setor saúde, de modo que se apresenta o público da política quase o dobro de vezes do que o serviço ofertado nesses materiais educativos. Conclusão: há mais categorias para se referir às populações-alvo das políticas sanitárias e penitenciárias do que aos espaços nos quais se recomenda que elas sejam alocadas. Em algumas áreas técnicas, quase cinco vezes mais, como se o processo de formulação dessas formas de ação estatal colaborasse para visibilizar indivíduos e ocultar instituições.

Objective: to describe and analyze categories to refer to people and establishments adopted in the health and justice sectors of the Federal Executive Branch thus accentuating the political dimension of the phenomenon of confinement in Brazil. Methods: we developed an overview of the results, highlighting the number and frequency of these categories. Our document analysis focused on primers and other educational materials identified and characterized after consulting four websites. Results: we gathered 147 documents, most of them with the purpose of raising social engagement, and a few defining norms. In the justice sectorwe found 412 records of expressions to refer to populations, and 274 to refer to establishments, as well as 619 and 390 in the health sector so that the policy target audience is presented almost twice as often as the service offered in these educational materials. Conclusion: there are more categories to refer to the target populations of health and penitentiary policies than to the spaces in which it is recommended that they be allocated. In some technical areas, almost five times more, as if the process of formulating these forms of state action collaborated to make individuals visible while hiding institutions.

Objetivo: describir y analizar categorías para referirnos a personas y establecimientos adoptados en los sectores de salud y justicia del Poder Ejecutivo Federal, acentuando así dimensión política del fenómeno del encierro carcelario en el Brasil. Metodología: Desarrollamos una perspectiva panorámica de los resultados obtenidos, destacando el número y frecuencia de estas categorías. Nuestro análisis documental se centró en folletos y otros materiales educativos, identificados y caracterizados después de consultar cuatro sitios web. Resultados: reunimos 147 documentos, la mayoría de estos con el propósito de crear compromiso social y en menor proporción para definir normas. En el sector justicia encontramos 412 registros de expresiones para referirse a poblaciones y 274 para referirse a los establecimientos, así como 619 y 390 en el sector salud, de este modo, es presentado el público de la política en casi el doble de veces que el servicio ofrecido en estos materiales educativos. Conclusión: hay más categorías para referirse a las poblaciones-alvo de políticas de salúd y penitenciarias, que a espacios en los cuales se recomienda que estas sean asignadas. En algunas áreas técnicas casi cinco veces más, como si el proceso de formulación de estas formas de acción estatal colaborara a hacer visibles a los individuos y ocultar las instituciones

Refusal of Treatment for Anorexia Nervosa: Mental Health Professionals' Opinion on Willingness and Role Stress. / Rechazo del tratamiento para la anorexia nerviosa: opinión de los profesionales de la salud mental sobre voluntariedad y estrés de rol.

INTRODUCTION: The hospitalisation of patients with anorexia nervosa poses an important bioethical quandary and can generate stress for the healthcare professionals. Our goal was to know and analyse the opinion of mental health professionals on some conditions for applying the involuntary hospitalisation of patients with anorexia nervosa. METHODS: Cross-sectional descriptive observational study on a sample of 270 mental health professionals, using an ad hoc questionnaire with scores ranging from 0 to 10. RESULTS: The professionals state that, in some cases, the patient accepts admission reluctantly: 7.74 (95% CI, 7.55-7.93). In the event of physical risk, it is difficult for them to combine respect for the patient's autonomy and the duty of care: 6.06 (95% CI, 5.70-6.41) and the relationship with the patient is largely oriented to convince them: 7.18 (95% CI, 6.91-7.46). They do not decide on the suitability of the participation of non-medical staff in the decision: 5.13 (95% CI, 4.75-5.52), or if the indication should correspond to someone other than the doctor in charge of their care: 4.79 (95% CI, 4.39-5.19). They reject the possibility of conscientious objection: 4.05 (95% CI, 3.68-4.41). CONCLUSIONS: Mental health professionals are subject to ambiguous work demands, which affects their care dynamics.

[Coronavirus disease 2019 (COVID-19): Involuntary admission yes, involuntary treatment no]. / Coronavirus disease 2019 (COVID-19): internamiento involuntario sí, tratamiento obligatorio no.

We had the opportunity to know a judicial decision in relation to a nonagenarian COVID-19 patient, which is clarifying regarding the complex issue of involuntary admission and involuntary treatment of the elderly. The judge authorized the involuntary admission but denied the possibility of imposing medical treatment against the will of the patient. This situation invites us to review the different types of involuntary admission that our legal system provides and how involuntary medical treatment is regulated according to its purpose and the patient's ability to decide. In the field of public health, the determining element to be able to impose any sanitary measure against the will of the patient is the risk to the health of the population. In the case presented, the judge rejects the possibility of authorizing medical treatment for not contributing anything from the point of view of public health. However, it does authorize involuntary admission as it is essential to guarantee isolation.

Mental Health Professionals' Attitudes Towards Mental Competency and Involuntary Commitment in Anorexia Nervosa: Construction, Validation and Results of the Acinovan Questionnaire. / Actitudes de los profesionales de la salud mental ante la capacidad y el internamiento no voluntario en anorexia nerviosa: construcción, validación y resultados del cuestionario ACINOVAN.

INTRODUCTION: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. OBJECTIVE: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. METHODS: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. RESULTS: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. CONCLUSIONS: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Effects of COVID-19 confinement measures on training loads and the level of well-being in players from Chile women's national soccer team / Efectos de las medidas de confinamiento por COVID-19 en el grado de bienestar y la carga de entrenamiento de las jugadoras de la selección nacional de fútbol de Chile

Abstract Introduction: Due to the current COVID-19 pandemic, many countries have implemented control and prevention measures, such as compulsory lockdowns, affecting all spheres of life. Since the field of professional soccer is no exception, such measures may have a negative impact on the player's well-being and their perceived training loads. Objective: To determine the impact of COVID-19 lockdown measures on the training load and the well-being of female professional soccer players in Chile. Materials and methods: Exploratory, cross-sectional, descriptive study conducted on 32 players of the Chile women's national soccer team. The perception of training load and the level of well-being were assessed by means of the rating of perceived exertion (RPE) scale and a questionnaire developed in 2010, respectively. Both the administration of the questionnaire and the permanent monitoring of the RPE records were carried out in two periods of 12 weeks: regular preparatory phase (12/12/2019-10/03/2020) and lockdown (16/03/2020-07/06/2020). Data were analyzed using descriptive statistics and the Wilcoxon test was used to determine if there were significant differences between periods. Results: Significant differences (p<0.05) and threshold effect sizes (ES)=1.2, 2.0 and 4.0 (large, very large, and extremely large, respectively) were found between both periods in all variables evaluated by the well-being questionnaire (except for sleep quality): muscle soreness and stress level (ES=1.9), perceived fatigue (ES=2.5), general well-being (ES=2.4), and mood (ES=4.2). No differences were found regarding the perception of the training load (ES=0.1) between both periods. Conclusions: The level of well-being among the participants was negatively affected by the compulsory lock-down. Therefore, coaching staffs should continue to monitor the level of the well-being of professional soccer players during the lockdown, both individually and collectively. Even though the perception of training load was not affected, it is not possible to state that a more extended period of confinement will not reduce it, resulting in a drop in performance.

Resumen Introducción. Debido a la actual pandemia por COVID-19, muchos países tomaron medidas de control y prevención como el confinamiento obligatorio, afectando todas las esferas de la vida. Ya que los futbolistas profesionales no son una excepción, este tipo de medidas puede tener un impacto negativo en su bienestar y en su percepción sobre las cargas de entrenamiento. Objetivo. Determinar los efectos de las medidas de confinamiento por COVID-19 en la carga de entrenamiento y el grado de bienestar de jugadoras de fútbol profesional de Chile. Materiales y métodos. Estudio transversal, exploratorio-descriptivo realizado en 32 jugadoras de la Selección Nacional de Fútbol de Chile. El grado de bienestar y la carga de entrenamiento se evaluaron mediante un cuestionario desarrollado en 2010 y mediante la escala de percepción subjetiva del esfuerzo (PSE) y el volumen de entrenamiento expresado en minutos, respectivamente. Ambas evaluaciones se realizaron en 2 periodos de 12 semanas : periodo preparatorio regular (12/12/2019-10/03/2020) y periodo de confinamiento (16/03/2020-07/06/2020). Los datos se analizaron mediante estadística descriptiva y la prueba de Wilcoxon se utilizó para determinar si hubo diferencias significativas entre ambos periodos. Resultados. Se encontraron diferencias significativas (p<0.05) y umbrales de tamaño del efecto (TE) iguales a 1.2, 2.0 y 4.0 (grande, muy grande y extremadamente grande, respectivamente) entre ambos periodos en todas las variables evaluadas por el cuestionario de bienestar (a excepción de calidad de sueño): dolor muscular y nivel de estrés (TE=1.9), fatiga percibida (TE=2.5), bienestar general (TE=2.4) y estado de ánimo (TE=4.2). No se observaron diferencias en la PSE (TE=0.1) entre ambos periodos. Conclusiones. El confinamiento obligatorio afectó negativamente el grado de bienestar de las participantes, por lo que es necesario que los cuerpos técnicos monitoreen constantemente, de manera individual y colectiva, el grado de bienestar de los futbolistas profesionales durante estos periodos; si bien la percepción en la carga de entrenamiento no se vio afectada, no es posible asegurar que un periodo mayor de confinamiento no la disminuya y esto resulte en una baja del rendimiento.

Prevalence of infectious diseases in a municipal hospital in Belem, northern Brazil / Prevalência de doenças infecciosas em um hospital municipal em Belém, Norte do Brasil / Prevalencia de enfermedades infecciosas enun hospital municipal de Belém, norte de Brasil

Background and objectives: Infectious diseases are still a public health problem in Brazil. Therefore, this study aimed to determine the prevalence of infectious diseases in a reference hospital in the city of Belem, Para, Brazil. Methods: From May 2018 to August 2019, the number of cases of individuals with compulsory infections was observed. Results: Regarding the research period in which data were obtained from May 2018 to August 2019, a total of 263 cases were affected in the hospital and in 2019 there was an increase in the number of cases and 373 records were reported. The following results were obtained: in 2018, the highest rate of infection was caused by influenza at the rate of 17%, and in 2019 it remained at the same percentage rate and ranked secondly. Conclusion: These data are very important for the epidemiological knowledge of the population, elucidating the highest case rates and lowering other diseases related to this study, as well as their harms and treatment.(AU)

Justificativa e objetivos: As doenças infecciosas ainda são um problema de saúde pública no Brasil. Por isso, este estudo teve como objetivo determinar a prevalência de doenças infecciosas em um hospital de referência na cidade de Belém, Pará, Brasil. Métodos: Foi observado, no período de maio de 2018 a agosto de 2019, número de casos de indivíduos acometidos com infecções de caráter compulsório. Resultados: Em relação ao período da pesquisa, no qual foram obtidos os dados de maio de 2018 a agosto de 2019, os resultados apontam que, nos meses de maio a dezembro de 2018, foram acometidos 263 casos no hospital e, em 2019, houve o aumento do número de casos, sendo notificados 373 registros. Obtiveram-se os seguintes resultados: no ano de 2018, a maior taxa de infecção foi causada pela influenza, com a taxa de 17%; em 2019, se manteve com a mesma taxa de percentual, ficando em segundo lugar. Conclusão: Esses dados são de suma importância para o conhecimento epidemiológico da população, elucidando sobre os maiores índices de casos e o decréscimo de outras doenças relacionadas a este estudo, bem como seus agravos e tratamento.(AU)

Justificacción y objetivos: las enfermedades infecciosas si guen siendoun problema de salud pública en Brasil. Por lo tanto, este estudio tuvo como objetivo determinar la prevalencia de enfermedades infecciosas en un hospital de referencia en la ciudad de Belém, Pará, Brasil. Métodos: desde mayo de 2018 hasta agosto de 2019, se observó el número de casos de personas con infecciones obligatorias. Resultados: En cuanto al período de la encuesta en el que se obtuvieron datos de mayo de 2018 a agosto de 2019, los resultados indican que de mayo a diciembre de 2018, 263 casos fueron afectados en el hospital y en 2019 huboun aumento enel número de casos y se reportaron 373 registros. Se obtuvieron lo ssiguientes resultados: en 2018, la tasa más alta de infección fue causada por la influenza a una tasadel 17%, y en 2019 se mantuvoenlamismatasa porcentual y ocupó el segundo lugar. Seguido de tuberculosis, donde el 15% de los casos notificados se registraron en 2018. En comparación con 2019 (19%) hu boun aumento del 4% en el número de personas afectadas, ocupando el primer lugar enel ranking de enfermedades notificadas. Seguido por el virus del SIDA donde se registró el 8% de los casos registrados, en comparación con 2019 (6%) se observó hasta ahora una disminución del 2% en el número de casos. Conclusión: Estos datos son muy importantes para el conocimiento epidemiológico de la población, ya que dilucidan las tasas de casos más altas y disminuy en otras enfermedades relacionadas con este estudio, sus enfermedades y su tratamiento.(AU)

Alternativas a los internamientos en salud mental: hospitalización domiciliaria desde la perspectiva española y anglosajona / Alternatives to admissions in mental health: home treatment from the Spanish and Anglo-Saxon perspective

En España, los internamientos por motivo de trastorno mental suelen implicar una pérdida de libertades, ya que en general se realizan en unidades de puertas cerradas o bajo condiciones de carácter restrictivo. En este artículo se revisan las características de estos internamientos y la legislación española al respecto. Se realiza una comparativa con Reino Unido, donde se dispone de una ley exclusivamente dedicada a la salud mental, y se analiza el modelo anglosajón de hospitalización domiciliaria como alternativa al ingreso hospitalario. En conclusión, existe una mayor protección legislativa de los derechos fundamentales de los usuarios de salud mental en Reino Unido respecto a España. Es necesaria una reforma legislativa y el desarrollo de políticas sanitarias dirigidas a reducir los internamientos y fomentar otras alternativas de tratamiento. La hospitalización domiciliaria ha demostrado ser una alternativa eficaz al ingreso hospitalario, permitiendo tratar a la persona en el ambiente menos restrictivo posible y un mayor respeto de su autonomía (AU)

In Spain, most of the admissions in mental health units imply a lack of freedom since they are carried out in facilities with closed doors or under restrictive conditions. This article analyzes the characteristics of those admissions and its legislation in Spain; then, it is compared with the United Kingdom model, where there is a specific law for mental health. We describe their model of home treatment, which is implemented as an alternative to hospital admissions. In conclusion, there is a better legislative protection of mental health users' fundamental rights in the United Kingdom than Spain. Legislative reform and the development of health policies to reduce hospitalizations and promote other treatment alternatives are necessary. Home treatment has proven to be an effective alternative to hospital admission, allowing the person to be treated in the least restrictive environment possible and greater respect for their autonomy (AU)

A Espanya, els internaments per motiu de trastorn mental solen implicar una pèrdua de llibertats, ja que en general es realitzen en unitats de portes tancades o sota condicions de caràcter restrictiu. En aquest article es revisen les característiques d'aquests internaments i la legislació espanyola sobre aquest tema. Es realitza una comparativa amb Regne Unit, on es disposa d'una llei exclusivament dedicada a la salut mental, i s'analitza el model anglosaxó d'hospitalització domiciliària com a alternativa a l'ingrés hospitalari. En conclusió, existeix una major protecció legislativa dels drets fonamentals dels usuaris de salut mental a Regne Unit respecte a Espanya. És necessària una reforma legislativa i el desenvolupament de polítiques sanitàries dirigides a reduir els internaments i fomentar altres alternatives de tractament. L'hospitalització domiciliària ha demostrat ser una alternativa eficaç a l'ingrés hospitalari, permetent tractar a la persona en l'ambient menys restrictiu possible i un major respecte de la seva autonomia (AU)

[Involuntary commitment of the psychiatric patient: legal regulations and critical aspects]. / Internamiento no voluntario del paciente psiquiátrico: normas legales y aspectos críticos.

Traditionally, medical care received by psychiatric patients involved their separation from the society through their isolation in closed institutions, thereby setting a stigmatising trend on the sick, and by extension on mental illness, a practice that somehow has remained until now. The profound changes in the field of psychiatry have been important and are reflected in the therapeutic field, as well as in the legislative one, and have contributed to establish changes concerning the social opinion about psychiatric patients. The purpose of this article is to review, from the critical perspective, the current legislative framework concerning the situation of involuntary psychiatric commitment as a therapeutic measure in the psychiatric patient, as well as the legal medical practice which indicates the lack of legal skills and ethical and professional conduct arising in the field of primary care.

Trayectoria de una joven reclusa en relación con el consumo de drogas y condicionamientos de género / Trajectory of a young female inmate in relation to drug use and gender-based constraints

RESUMEN Este texto se propone analizar aspectos socioculturales en relación con la trayectoria de consumo habitual de sustancias psicoativas de una joven reclusa. La joven se encontraba en un centro de reclusión para menores en Medellín, donde se realizaron entrevistas y observación participante. Se evidenció la importancia de aspectos relativos al género como elemento protector y también de riesgo. Finalmente, se presentan algunos elementos relativos al proceso de desintoxicación mientras cumplía su sanción en internamiento.(AU)

ABSTRACT This text aims to analyze socio-cultural aspects in relation to the trajectory of habitual consumption of psychoactive substances of a young inmate. The young woman was in a detention center for minors in Medellin, Colombia, where interviews were conducted and participant observation was carried out. From there, the importance of aspects related to gender as a protective and risk elements was evident. Finally, this study presents some elements related to the detoxification process while she was following her sanction in internment.(AU)

A internação compulsória como estratégia de governamentalização de adolescentes usuários de drogas / The compulsory hospitalization as a governmentalization strategy for the adolescent drug users / El internamiento como estrategia de gobernamentalización de adolescentes consumidores de drogas

Resumo Este artigo tem como objetivo problematizar a internação compulsória de adolescentes usuários de drogas em um serviço de saúde mental de Porto Alegre/RS a partir da noção de Biopolítica, proposta por Michel Foucault. Assim, primeiramente, descrevemos o processo de internação compulsória e os percursos dos jovens no serviço para depois avançarmos na análise da internação compulsória como uma estratégia de governamentalização da vida. Esta análise leva para a desnaturalização das ações contemporâneas do Estado direcionadas aos adolescentes usuários de drogas e aos atravessamentos dos interesses de mercado que operam no contexto dessa política. Por fim, apontamos a suspensão dos elementos universais que permeiam a temática das drogas como possibilidade de ruptura dos padrões de cuidado até então colocados no campo da saúde.(AU)

Abstract This article aims to discuss the compulsory hospitalization of adolescent drug users in a mental health service in the city of Porto Alegre/RS from the notion of Bio-politics, proposed by Michel Foucault. So, first, we describe the process of compulsory hospitalization and the passages of young people in the service, and thus we move to the analysis of compulsory hospitalization as a strategy of governmentalization of life. This analysis leads to the denaturalization of contemporary state actions directed to adolescent's drug users and the crossings market interests operating in the context of this policy. Finally, we point to the suspension of the universal elements that permeate the theme of drugs as a possibility to break off the standards of care placed in the health field.(AU)

Resumen Ese artículo tiene como objetivo problematizar el internamiento forzado de adolescentes consumidores de drogas en un servicio de salud mental de Porto Alegre/RS a partir de la noción de la Biopolítica, propuesta por Michel Foucault. Así, primero, describimos el proceso de internamiento forzado y el camino de los jóvenes en el servicio investigado como un fenómeno inherente al campo de la problemática de las racionalidades del gobierno de las conductas. Análisis que desnaturaliza las acciones de hoy día del Estado dirigidas a los adolescentes consumidores de drogas al discutir los intereses del mercado que operan en el contexto de esa política. Por último, apuntamos la suspensión de los elementos universales que permean la temática como posibilidad de rotura de los patrones de cuidado hasta el momento colocados en el campo.(AU)

A internação compulsória como estratégia de governamentalização de adolescentes usuários de drogas / The compulsory hospitalization as a governmentalization strategy for the adolescent drug users / El internamiento como estrategia de gobernamentalización de adolescentes consumidores de drogas

Resumo Este artigo tem como objetivo problematizar a internação compulsória de adolescentes usuários de drogas em um serviço de saúde mental de Porto Alegre/RS a partir da noção de Biopolítica, proposta por Michel Foucault. Assim, primeiramente, descrevemos o processo de internação compulsória e os percursos dos jovens no serviço para depois avançarmos na análise da internação compulsória como uma estratégia de governamentalização da vida. Esta análise leva para a desnaturalização das ações contemporâneas do Estado direcionadas aos adolescentes usuários de drogas e aos atravessamentos dos interesses de mercado que operam no contexto dessa política. Por fim, apontamos a suspensão dos elementos universais que permeiam a temática das drogas como possibilidade de ruptura dos padrões de cuidado até então colocados no campo da saúde.

Abstract This article aims to discuss the compulsory hospitalization of adolescent drug users in a mental health service in the city of Porto Alegre/RS from the notion of Bio-politics, proposed by Michel Foucault. So, first, we describe the process of compulsory hospitalization and the passages of young people in the service, and thus we move to the analysis of compulsory hospitalization as a strategy of governmentalization of life. This analysis leads to the denaturalization of contemporary state actions directed to adolescent's drug users and the crossings market interests operating in the context of this policy. Finally, we point to the suspension of the universal elements that permeate the theme of drugs as a possibility to break off the standards of care placed in the health field.

Resumen Ese artículo tiene como objetivo problematizar el internamiento forzado de adolescentes consumidores de drogas en un servicio de salud mental de Porto Alegre/RS a partir de la noción de la Biopolítica, propuesta por Michel Foucault. Así, primero, describimos el proceso de internamiento forzado y el camino de los jóvenes en el servicio investigado como un fenómeno inherente al campo de la problemática de las racionalidades del gobierno de las conductas. Análisis que desnaturaliza las acciones de hoy día del Estado dirigidas a los adolescentes consumidores de drogas al discutir los intereses del mercado que operan en el contexto de esa política. Por último, apuntamos la suspensión de los elementos universales que permean la temática como posibilidad de rotura de los patrones de cuidado hasta el momento colocados en el campo.

Sobre jovens drogaditos: as histórias de ninguém / Acerca de jóvenes drogadictos: las historias de nadie / About young drug users: the stories of no one

O presente estudo parte do crescente processo de judicialização do cuidado em saúde mental de jovens usuários de drogas e tem por objetivo problematizar a forma como, na relação entre os campos da Saúde Mental e da Justiça, vai se desenvolvendo uma biopolítica voltada para o governo da população de "adolescentes drogaditos". Para tanto, realizamos a análise de processos judiciais de internação compulsória de jovens por uso de drogas. Fundamentamo-nos nas ferramentas teóricas e metodológicas da Psicologia Social, dentro de uma perspectiva pós-estruturalista, especialmente no que se refere ao pensamento de Michel Foucault, na forma como o autor desenvolveu uma análise dos discursos e da emergência dos saberes na sua articulação com mecanismos e tecnologias de poder. A partir dessa perspectiva, evidenciamos a forma como essa biopolítica, embora aja em nome da garantia de direitos, opera produzindo vulnerabilidades.(AU)

El presente estudio parte del creciente proceso de judicialización del cuidado en salud mental de jóvenes usuarios de drogas y tiene por objeto problematizar la forma como, en la relación entre los campos de la Salud Mental y la Justicia, se va desarrollando una biopolítica orientada al gobierno de la población de "adolescentes drogadictos". Se ha llevado a cabo el análisis de procesos judiciales de internamiento forzoso de jóvenes por uso de drogas. El estudio está fundamentado en las herramientas teóricas y metodológicas de la Psicología Social, dentro de una perspectiva postestructuralista, especialmente en lo que atañe al pensamiento de Michel Foucault y la forma como desarrolló el análisis de los discursos y la emergencia de los saberes en su articulación con mecanismos y tecnologías de poder. A partir de éstos, se evidencia cómo dicha biopolítica, aunque actúe a nombre de la garantía de los derechos, opera produciendo vulnerabilidad.(AU)

The present study addresses the increasing process of judicialization of mental health care of young drug users, and aims at problematizing the way in which a biopolitics directed towards the government of the population of 'addicted teenagers' has been developed in the relationship between the fields of Mental Health and Justice. The development of this research is based on the analysis of lawsuits of adolescents that had been ordered the protective measure of psychiatric hospitalization for treatment for drug addiction. We have based our study on the theoretical and methodological tools of Social Psychology, especially with regard to the work of Michel Foucault, in the way that this author developed an analysis of both discourses and the emergence of knowledges in their articulation with power mechanisms and technologies. By analyzing these documents, we have attempted to identify that this biopolitics, in spite of guaranteeing rights, operates by producing vulnerabilities.(AU)

Sobre jovens drogaditos: as histórias de ninguém / Acerca de jóvenes drogadictos: las historias de nadie / About young drug users: the stories of no one

O presente estudo parte do crescente processo de judicialização do cuidado em saúde mental de jovens usuários de drogas e tem por objetivo problematizar a forma como, na relação entre os campos da Saúde Mental e da Justiça, vai se desenvolvendo uma biopolítica voltada para o governo da população de "adolescentes drogaditos". Para tanto, realizamos a análise de processos judiciais de internação compulsória de jovens por uso de drogas. Fundamentamo-nos nas ferramentas teóricas e metodológicas da Psicologia Social, dentro de uma perspectiva pós-estruturalista, especialmente no que se refere ao pensamento de Michel Foucault, na forma como o autor desenvolveu uma análise dos discursos e da emergência dos saberes na sua articulação com mecanismos e tecnologias de poder. A partir dessa perspectiva, evidenciamos a forma como essa biopolítica, embora aja em nome da garantia de direitos, opera produzindo vulnerabilidades.

El presente estudio parte del creciente proceso de judicialización del cuidado en salud mental de jóvenes usuarios de drogas y tiene por objeto problematizar la forma como, en la relación entre los campos de la Salud Mental y la Justicia, se va desarrollando una biopolítica orientada al gobierno de la población de "adolescentes drogadictos". Se ha llevado a cabo el análisis de procesos judiciales de internamiento forzoso de jóvenes por uso de drogas. El estudio está fundamentado en las herramientas teóricas y metodológicas de la Psicología Social, dentro de una perspectiva postestructuralista, especialmente en lo que atañe al pensamiento de Michel Foucault y la forma como desarrolló el análisis de los discursos y la emergencia de los saberes en su articulación con mecanismos y tecnologías de poder. A partir de éstos, se evidencia cómo dicha biopolítica, aunque actúe a nombre de la garantía de los derechos, opera produciendo vulnerabilidad.

The present study addresses the increasing process of judicialization of mental health care of young drug users, and aims at problematizing the way in which a biopolitics directed towards the government of the population of 'addicted teenagers' has been developed in the relationship between the fields of Mental Health and Justice. The development of this research is based on the analysis of lawsuits of adolescents that had been ordered the protective measure of psychiatric hospitalization for treatment for drug addiction. We have based our study on the theoretical and methodological tools of Social Psychology, especially with regard to the work of Michel Foucault, in the way that this author developed an analysis of both discourses and the emergence of knowledges in their articulation with power mechanisms and technologies. By analyzing these documents, we have attempted to identify that this biopolitics, in spite of guaranteeing rights, operates by producing vulnerabilities.

Reducción de la morbilidad y de los costos hospitalarios en cirugía cardiaca, mediante una estrategia prequirúrgica ambulatoria / Morbidity and hospital cost reduction in cardiac surgery using a presurgery ambulatory strategy

Los pacientes que van a una cirugía electiva de corazón, se internan a través de una lista de espera de admisión hospitalaria. Desde 1999 existe en el Instituto Nacional de Cardiología Ignacio Chávez, la "vía rápida de internamiento" para pacientes de bajo riesgo quirúrgico, que en el 2004 se extendió a riesgo moderado, tomando como base criterios propios y criterios internacionalmente aceptados. Objetivos: 1) comparar las dos alternativas de internamiento utilizadas actualmente: vía de internamiento rápido; y el internamiento a través de la lista de espera del departamento de admisión, tomando en consideración los eventos mayores que presentaron como: muerte o complicaciones que prolongaron la estancia hospitalaria a más de 14 días (Infecciones, reoperación, alteraciones del ritmo y de la conducción y otros). 2) Comparar los días de estancia y consumo de recursos hospitalarios. Métodos: Se tomaron dos cohortes de 347 pacientes, el grupo control fue obtenido de la lista de espera del departamento de admisión, mientras que el grupo de la vía de internamiento rápido, tuvo como requisito tener los estudios preoperatorios completos y a los enfermos con comorbilidad resuelta o compensada. Los gastos generados al hospital por cada paciente se calcularon de acuerdo a la clasificación socioeconómica de los enfermos. Análisis estadístico: Se utilizó la prueba t de Student para muestras independientes y variables numéricas y Ji cuadrada para las variables categóricas, se consideró significativo un valor de p < 0.05. Resultados: Ambos grupos se conformaron por un promedio de 75% con patología valvular y 25% con patología congénita simple, 49.9% fueron mujeres, la edad promedio fue de 47 ± 15 años. Las comparaciones del grupo de la vía de internamiento rápido con el grupo admitido a través de la lista de admisión fueron: Mortalidad: 4.3% vs. 5.8% (p = 0.38). Eventos mayores que ameritaron una estancia hospitalaria mayor a 14 días: 73 vs. 97 casos respectivamente (p = 0.032). Procesos infecciosos en general: 22 vs. 29 (p = 0.14). Mediastinitis: dos vs. nueve respectivamente (p = 0.033). Días de estancia hospitalaria: 11 vs. 20 (p = 0.0001). La mayor diferencia se encontró en el tiempo preoperatorio: dos vs. nueve días respectivamente (p = 0.0001). Conclusión: La morbilidad posquirúrgica en conjunto fue significativamente menor en el grupo de la vía de internamiento rápido, y dentro de esta, las mediastinitis se presentaron con menor frecuencia, con diferencia estadística. El tiempo preoperatorio fue mucho menor en el grupo de la vía de internamiento rápido, esto disminuyó el tiempo de exposición a microorganismos nosocomiales lo que creemos puede explicar la disminución de los eventos de mediastinitis. Finalmente, la reducción en el tiempo de hospitalización en el grupo de la vía de internamiento rápido, dio como resultado un ahorro monetario para el hospital de 32%.

In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. Objectives: 1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital. Methods: We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. Statistical analysis: Student t test was conducted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p < 0.05 to be statistically significant. Results: In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47± 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001). Conclusion: The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission and operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.

La genealogía de los niños de la calle y su educación en los Centros de Internamiento en México / A genealogía dos meninos da rua e sua educação nos internatos de México / The genealogy of street children and their education in detention centers in Mexico

Los niños y niñas de la calle y en la calle no sólo enfrentan problemas en la sociedad, sino también dentro de las instituciones que los controlan punitivamente. Los hoy llamados Centros de Internamiento han sido parte de diversas instancias gubernamentales, las cuales aplican a los niños y niñas programas educativos paliativos. Actualmente, los niños y niñas son llamados adolescentes para poder ser juzgados como sujetos adultos.El problema de los sujetos menores “delincuentes” no es problema de justicia, es un problema de educación; para tal fin debe hacerse cargo una institución educativa que tenga la infraestructura y los recursos pedagógicos paraatenderlos.

As meninos e meninas abandonados nas ruas não somente enfrentam os problemas na sociedade como também dentro das instituições que as controlam com castigos. Atualmente os chamados internatos, emdiferentes escalas públicas aplicam castigos sos meninos e meninas. Atualmente também as meninas e meninos são considerados adolescentes para poder serem julgados como adultos. O problema dos menores “delinquentes” não é um problema da justiça, é um problema da educação; para solucionar o problema se recomenda una instituição educativa com infraestructura e recursos pedagógicos adequados para atender-los.

Street children not only face problems in society, but also within the institutions that control punishes. The called Detention Centers have been part of various government bodies which apply only to children hospice programs for their training. Currently, children are called adolescents to be able to be tried as adults. The problem of “criminals” children is not justice problem is a problem of education, for such purpose should be charge the Secretariat of Public Education that has human infrastructure and educational resources to address them.

La cenicienta adolescente: mujer, criminalidad e internamiento en la jurisdicción penal juvenil de Costa Rica / Cenicienta adolescent: woman, criminality and youthful the penal jurisdiction of Costa Rica

En Costa Rica, el factor de género dentro de las cifras de internamiento registradas en materia Penal Juvenil es el que más dramáticamente proyecta diferencias marcadas entre los jóvenes y adolescentes que han sido privados de su libertad tanto de manera cautelar o como sanción.

In Costa Rica, according to the imprisonment statistics registered in the Juvenile Criminal Law System, gender is the factor that most dramatically projects deep differences among the youth and adolescent population that has been arrested or sentenced.