Lessons from the historical dynamics of environmental law enforcement in the Brazilian Amazon.

Here, we analyze critical changes in environmental law enforcement in the Brazilian Amazon between 2000 and 2020. Based on a dataset of law enforcement indicators, we discuss how these changes explain recent Amazon deforestation dynamics. Our analysis also covers changes in the legal prosecution process and documents a militarization of enforcement between 2018 and 2022. From 2004 to 2018, 43.6 thousand land-use embargoes and 84.3 thousand fines were issued, targeting 3.3 million ha of land, and totaling USD 9.3 billion in penalties. Nevertheless, enforcement relaxed and became spatially more limited, signaling an increasing lack of commitment by the State to enforcing the law. The number of embargoes and asset confiscations dropped by 59% and 55% in 2019 and 2020, respectively. These changes were accompanied by a marked increase in enforcement expenditure, suggesting a massive efficiency loss. More importantly, the creation of so-called conciliation hearings and the centralization of legal processes in 2019 reduced the number of actual judgments and fines collected by 85% and decreased the ratio between lawsuits resulting in paid fines over filed ones from 17 to 5%. As Brazil gears up to crack-down on illegal deforestation once again, our assessment suggests urgent entry points for policy action.

Contribuições da educação permanente para os conselhos de saúde: um estudo de revisão integrativa / Contributions of continuingeducation tothehealth councils: an integrative review study / Contribuciones de la educación continua a los consejos de salud: un estudio de revisión integradora

Introdução:Aeducação permanente propicia uma reflexão contínua frente à realidade posta e nos instiga a buscar soluções criativas para a superação dos problemas de saúde e, por conseguinte, qualificar as ações dos conselheiros de saúde, no intuito de aumentar a resolubilidade, a qualificação técnica e a eficiência do sistema de saúde.Objetivo:Analisar as contribuições da educação permanente para os Conselhos de Saúde.Metodologia:Trata-se de uma revisão integrativa da literatura científicaguiada pelo checklistIndicativos de Qualidade para Artigos de Revisão Integrativa, realizada em julho de 2021 e atualizada em junho de 2023.Resultados:Os 15 artigos incluídos na amostra final versam, em sua maioria, sobre os Conselhos Municipais de Saúde (73%), são decorrentes de estudos realizados no Sudeste do Brasil (60%) e foram publicados nos últimos vinte anos, com maior frequência em 2011 (20%). As congruências identificadas nos artigos foram organizadas em três categorias: 1) O papel do conselheiro de saúde; 2) Desafios encontrados no exercício do controle social; 3) A qualificação para o aperfeiçoamento dos processos decisórios dos Conselhos de Saúde. Os achados do estudo mostram que a falta de conhecimentos específicos e a ausência de ações de educação permanente para os conselheiros de saúde dificultam os processos decisórios e deliberativos dos Conselhos de Saúde.Conclusões:As consequências da falta de conhecimento sobre os temas pertinentes ao exercício do controle social têm grande influência na condução de políticas públicas e do sistema de saúde no Brasil (AU).

Introduction:Continuing education provides continuous reflection in the face of the imposed reality and encourages us to seek creative solutions to overcome health problems and, consequently, qualify the actions of health counselors, in order to increase solvability, technical qualification and efficiency of the health system. Objective:To analyze the contributions of continuing education to the Health Councils.Methodology:This is an integrative review of the scientific literature guided by the Quality Indicators forIntegrative Review Articles checklist, carried out in July 2021 and updated in June 2023. Results:Most of the 15 articles included in the final sample are about Municipal Health Councils (73%), are the result of studies carried out in the southeast of Brazil (60%) and were published in the last 20 years, most frequently in 2011 (20%). The congruences identified in the articles were organized into three categories: 1) The role of the health counselor; 2) Challenges found in the exercise of social control; 3) The qualification for the improvement of the decision-making processes of the Health Councils. The study findings show that the lack of specific knowledge and the absence of continuing education actions for health counselors hinder the decision-making and deliberative processes of the Health Councils. Conclusions:The consequences of the lack of knowledge about issues related to the exercise of social control have a great influence on the conduct of public policies and the health system in Brazil (AU).

Introducción: La educacióncontinua proporciona una reflexión continua frente a la realidad planteada y nos impulsa a buscar soluciones creativaspara superar los problemas de salud y, por lo tanto, calificar las acciones de los consejeros de salud, con el fin de aumentar la resolutividad, la calificación técnica y la eficiencia del sistema de salud. Objetivo: Analizar las contribuciones de la educación continua a los Consejos de Salud.Metodología: Esta es una revisión integradora de la literatura científica guiada por la lista de verificación Indicadores de Calidad para Artículos de Revisión Integradora, realizada en julio de 2021 y actualizada enjunio de 2023. Resultados: Los 15 artículos incluidos en la muestra final son en su mayoría sobre Consejos Municipales de Salud (73%), son resultado de estudios realizados en el Sudeste de Brasil (60%) y fueron publicados en los últimos 20 años, con mayorfrecuencia en 2011 (20%). Las congruencias identificadas en los artículos fueron organizadas en tres categorías: 1) El papel del consejero de salud; 2) Desafíos encontrados en el ejercicio del control social; 3) La capacitación para la mejora de los procesos de toma de decisiones de los Consejos de Salud. Los hallazgos del estudio muestran que la falta de conocimientos específicos y la ausencia de acciones de educación continua para los consejeros de salud dificultan la toma de decisiones y los procesos deliberativos de los Consejos de Salud.Conclusiones: Las consecuencias de la falta de conocimiento sobre cuestiones relacionadas con el ejercicio del control social tienen una gran influencia en la conducción de las políticas públicas y el sistema de salud en Brasil (AU).

Coordenadoria de Regulação

Complexo Regulador do Município de São Paulo, órgão integrante da Secretaria Municipal de Saúde (SMS), teve o início de suas atividades a partir de 2003, em conformidade com as diretrizes da Norma Operacional de Assistência à Saúde (NOAS) de 2002 do Ministério da Saúde. A função dos complexos reguladores é organizar a relação entre a oferta e a demanda qualificando o acesso da população aos serviços de saúde no SUS de forma ordenada e equânime, fornecendo subsídios para o planejamento em saúde. Também faz parte da Coordenação de Regulação Assistencial o programa de Telessaúde Redes que permite o esclarecimento de dúvidas de profissionais da Atenção básica da SMS através da teleconsultoria e a elaboração de protocolos de acesso e protocolos clínicos para os serviços disponíveis na rede. Outro programa da Coordenação é o Alô Mae que conta com ações de tele orientação às gestantes e puérperas, além da identificação precoce de RN de risco e mal formações congênitas para agendamento na rede municipal.

339ª Reunião do Conselho Nacional de Saúde - 15 feb. 2023

The human cost of economic sanctions and strategies for building health system resilience: A scoping review of studies in Iran.

OBJECTIVES: This review aimed to analyse the impacts of international economic sanctions on the overall health status of Iranians and the health system performance of Iran, in addition to identifying effective strategies for making the health system resilient to sanctions. STUDY DESIGN: A scoping review. METHODS: Three databases and grey literature were reviewed, and additional papers were identified in the lists of references. Two authors reviewed papers to check duplications and screen through inclusion/exclusion criteria. Furthermore, a narrative approach was employed to synthesise the findings. RESULTS: Given overall health impacts, economic sanctions are believed to have adverse effects on Iranian's health and cause significant financial hardships in accessing healthcare services. These hardships mostly affect those in marginalised and vulnerable groups. Economic sanctions degrade Iran's health system by negatively impacting health services' availability. The detrimental effects of sanctions on economic and social circumstances were also documented. Economic sanctions could also adversely affect health research and education. Most strategies identified for health system resilience to sanctions are related to the health system governance. CONCLUSIONS: Even if essential medicines and supplies are exempted from the sanction regime, the impact of economic sanctions on public health is unavoidable. The quantification of the effect economic sanctions on different health-related areas needs by further research. The measures identified for dealing with sanction can be considered in other countries but more work is needed to explore how health of people can be resilient against negative consequences of sanctions.

"It is a different type of policing than in the bush": Police officers' perceptions of the differences in enforcement of the phone use while driving legislation in rural and urban areas.

Mobile phone use while driving continues to be a significant road safety concern, despite the severe legal countermeasures to reduce this behaviour. Phone use while driving-related crashes have been demonstrated to be an issue in rural areas, yet research into the impact of legal sanctions on phone use while driving has primarily focussed on urban areas. Therefore, this study aimed to investigate differences in enforcement of phone use while driving between rural and urban environments as reported by police officers. In addition, to provide necessary context, this study aimed to explore how the police officers perceive differences in drivers' engagement in phone use while driving between rural and urban environments. To address these aims, a total of 26 police officers from Queensland, Australia (18 with both rural and urban experience, 6 with only rural experience and 2 with only urban experience) completed an interview. A total of seven themes were developed from the data. Several differences between rural and urban environments were identified concerning different types of phone offending behaviour, as well as different resources, management and infrastructure that can impact police enforcement. For example, it was suggested that drivers in rural areas have less reasons to use their phone while driving. Nevertheless, when this behaviour does occur, it is more challenging to enforce this law in rural compared to urban environments. The results not only provide important contextual information for phone use while driving research, but also suggest that enforcement strategies for this behaviour may need to be recontextualised to incorporate the more nuanced aspects of rural policing.

What's risk got to do with it: Judges' and probation officers' understanding and use of juvenile risk assessments in making residential placement decisions.

OBJECTIVE: This hypothetical vignette-based experiment was designed to better understand judges' and probation officers' interpretations and use of juvenile risk assessment tools in their decision-making around restrictive sanctions and confinement of youths on the basis of the youths' risk level and race. HYPOTHESES: We expected that estimates of the probability of juvenile recidivism would significantly mediate the relationship between a categorical risk descriptor and decisions regarding the ordering confinement of youths. We also hypothesized that youths' race would serve as a significant moderator in the model. METHOD: Judicial and probation staff (N = 309) read a two-part vignette about a youth who was arrested for the first time; in this vignette, race (Black, White) and risk level (low, moderate, high, very high) of the youth were varied. Participants were asked to estimate the likelihood that the youth would recidivate in the following year and their likelihood of ordering or recommending residential placement. RESULTS: Although we found no simple, significant relationship between risk level and confinement decisions, judicial and probation staff estimated higher likelihoods of recidivism as risk-level categories increased and ordered out-of-home placements at increased rates as their estimations of the youth's likelihood of recidivation increased. The youth's race did not moderate the model. CONCLUSION: The greater the probability of recidivism, the more likely each judge or probation officer was to order or recommend out-of-home placement. However, importantly, legal decisionmakers appeared to apply categorical risk assessment data to their confinement decisions using their own interpretations of risk category rather than being guided empirically on the basis of risk-level categories. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Beyond "Chilling Effects": Latinx and Asian Immigrants' Experiences With Enforcement and Barriers to Health Care.

OBJECTIVES: Immigration enforcement policies are associated with immigrants' barriers to health care. Current evidence suggests that enforcement creates a "chilling effect" in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants' direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants' encounters with law and immigration enforcement and assessed associations with health care access. METHODS: We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care. RESULTS: Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10-1.50). There were no associations with the usual source of care. CONCLUSION: Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants' enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants' access to care.

Harnessing the Promise of Artificial Intelligence Responsibly.

This Viewpoint discusses the benefits and potential harms of using artificial intelligence (AI) algorithms in medicine and proposes the collaborative creation of a Code of Conduct for AI in Health Care.

Anexos 9, 10 y 11 del 55.º informe del Comité de Expertos de la OMS en Especificaciones para las Preparaciones Farmacéuticas

Versión oficial en español de los anexos 9, 10 y 11 de la obra original: WHO Expert Committee on Specifications for Pharmaceutical Preparations: fifty-fifth report. © World Health Organization, 2021. ISBN 978-92-4-002090-0 (PDF).

Anarchy and Its Overlooked Role in Health and Healthcare.

In this paper, I will argue that a number of well-known health interventions or initiatives could be considered anarchist, or at the very least are consistent with anarchist thinking and principles. In doing this I have two aims: First, anarchism is a misunderstood term-by way of example, I hope to first sketch out what anarchist solutions in health and healthcare could look like; second, I hope to show how anarchist thought could stand as a means to improve the health of many, remedying health inequalities acting as a buffer for the many harms that threaten health and well-being. On this second point, I will argue that there are a number of theoretical and instrumental reasons why greater engagement with anarchism and anarchist thinking is needed, along with how this could contribute to health and in addressing broader injustices that create and perpetuate poor health.

Gestão do trabalho nas redes de saúde: aprendizagens no desenvolvimento do Sistema Único de Saúde no Espírito Santo / Management of work in health networks: lessons learned in the development of the Unified Health System in Espírito Santo

A coletânea "Gestão do trabalho nas redes: aprendizagens no desenvolvimento do Sistema Único de Saúde no Espírito Santo", tem o objetivo de compartilhar os trabalhos realizados no Projeto intitulado "Programa de Educação Permanente em Saúde para o desenvolvimento de capacidades docentes aos trabalhadores do sistema estadual de saúde do Espírito Santo". Tal projeto constitui uma experiência exitosa que envolveu múltiplos ciclos formativos e possibilitou a produção crítica e protagonista dos trabalhadores. Assim, a coletânea nos apresenta um pouco do cotidiano da Gestão do trabalho e das redes em saúde produzidas ­ e desejadas ­ em território capixaba. A partir das múltiplas experiências, as quais perpassam os três níveis de atenção, revelando caminhos inovadores e criativos da Gestão do Trabalho em rede no Espírito Santo, percebe-se o trabalho como um processo vivo, caracterizado por trocas, corresponsabilização e esforços coletivos, capaz de resultar em comprometimento e ganhos mútuos. As narrativas advindas do cotidiano do fazer saúde apontam a relevância da valorização do trabalhador da saúde e do seu trabalho, subsidiando debates acerca dos espaços de discussão e negociação das relações e condições de trabalho em saúde, oportunidades de capacitação e educação permanente dos trabalhadores, dentre outras ações as quais resultam na análise crítica intrínseca para a qualificação do processo de trabalho. É a partir desses elementos que convidamos você, caro leitor, a visitar as experiências de Gestão do Trabalho no SUS capixaba. Prometemos um percurso narrativo repleto de potencialidades que nos provocam a pensar em redes de saúde inclusivas, equânimes e integrais, a partir de uma teia que envolve trabalhadores, usuários, gestão, ensino e controle social, todas e todos comprometidos com processos justos e éticos em defesa da vida.

Conceptualising informal institutions: Drawing on the case of guanxi.

Institutions regulate social life through formal rules and sanctions. These are distinguished from another source of social regulation, the informal incentives and constraints inherent in cultural currents and customary practices. Informal practices may be based not simply on cultural forces, though, but expectations regularised by informal rules and sanctions, which may operate as informal institutions. One approach holds that informal institutions arise out of formal institutional voids. Another holds that informal institutions operate in response to situations in which formal institutions frustrate the interests of individuals and groups who engage informal institutions to augment, compromise, or subvert formal institutions. After developing the concept of informal institution, the article goes on to indicate how an informal relationship pervasive in modern China, guanxi, may be understood as an informal institution. It is shown that by drawing on the case of guanxi the scope of the concept informal institution can be extended and also that our understanding of guanxi is enriched when the concept of informal institution is applied to its analysis.

"Missing Persons": Absent Voices of People with Dementia in the Australian Royal Commission into Aged Care.

This article argues the voice of people with dementia was missing from the Australian Royal Commission into Aged Care Quality and Safety (RCAC) Final Report. This absence was notwithstanding that the RCAC was explicitly tasked to inquire into dementia care. The RCAC Final Report is shown to marginalise the perspective and experience of people with dementia in the aged care system at the same time as prioritising substitute voices of experts, advocates, family and care partners. This absence of voice repeats and re-inscribes framing of people with dementia as "missing persons". Where people with dementia face practical and legal barriers to participate in civic and legal processes, the RCAC failed to adjust its methodologies to ensure their voices were "heard". The RCAC's re-inscription of marginalisation of people with dementia raises concerns for the legitimacy and success of its recommendations for dementia aged care reform.

Análise de propostas legislativas brasileiras sobre a publicidade de alimentos / Analysis of Brazilian legislative proposals on food advertising

Introdução: O consumo de alimentos ultraprocessados está crescendo no Brasil e tem como um de seus determinantes a exposição à publicidade de alimentos não saudáveis, especialmente de crianças. Apesar disso, as normas brasileiras governamentais não têm se mostrado efetivas na proteção da exposição da população ao conteúdo de publicidade desses alimentos, enquanto a atuação autorregulatória apresenta limitações. Conhecer as propostas legislativas brasileiras no tema tornará possível pensar caminhos para a redução da exposição da população ao conteúdo publicitário sobre alimentos não saudáveis. Objetivo: Analisar a conteúdo de propostas legislativas sobre a publicidade de alimentos no Brasil. Metodologia: Este estudo de análise documental se dividiu na (i) construção de um glossário com termos específicos das áreas de saúde pública, nutrição, publicidade e legislação, a fim de oferecer um referencial terminológico para a análise, e na (ii) coleta, organização e compilação de um banco de textos, permitindo análises quantitativas e qualitativas dos dados de propostas legislativas de publicidade de alimentos. Foram utilizados três tipos de análise: Classificação Hierárquica Descendente, Análise Fatorial Confirmatória e Análise de Similitude, com auxílio do software IRAMUTEQ. O banco de textos foi organizado a partir da coleta de dados no site do Congresso Nacional, usando-se os termos de busca "marketing de alimentos", "propaganda de alimentos", "publicidade de alimentos", "promoção de alimentos", "comunicação mercadológica" e "divulgação de alimentos". Resultados: Foi produzido um glossário com 29 termos a fim de clarificar conceitos relacionados à regulação de publicidade de alimentos em território nacional. O banco de textos foi composto por 19 resultados relevantes. As propostas analisadas possuem cerca de 20 anos, sendo que a maioria das iniciativas vêm da Câmara dos Deputados. Seis das propostas estabelecem atualização do Decreto-Lei Nº 986/1969. Dentre os textos mais significativos, destaca-se uma proposta de emenda constitucional que incluiria alimentos e bebidas na lista de produtos sujeitos a regulamentações de publicidade comercial e quatro propostas similares que contemplam a regulamentação da publicidade de forma ampla. Apenas duas propostas estão em tramitação. Durante a análise textual, foram identificadas quatro grandes classes temáticas: Saúde (37,3% do corpus analisado), Regulamento (35,4%), Aspecto Comercial (12,9%) e Teor Nutricional (14,5%). A classe Saúde corresponde a palavras relacionadas a sintomas de uma população ligados ao consumo de alimentos não-saudáveis. A classe Regulamento contém palavras que se referem a regulamentação legislativa sobre publicidade. A classe Aspecto Comercial, como o nome diz, inclui palavras que se referem a aspectos comerciais dos alimentos (ex: rótulo, aditivo, sabor). A classe Teor Nutricional apresenta termos relacionados a informação nutricional dos alimentos. A análise fatorial confirmatória corroborou a distribuição de palavras em quatro classes temáticas. A análise de similitude identificou cinco ramificações principais a partir da palavra central "alimento", que se relacionam com a legislação, propaganda, público infantil, obesidade e gordura/trans/saturado/sódio. Conclusão: As análises indicam que as propostas são alinhadas à tendências globais sobre medidas de prevenção à obesidade. Contudo, a tramitação de projetos é lenta e complexa, além de sofrer interferências de setores econômicos.

Introduction: The consumption of ultra-processed foods is growing in Brazil, and one of its determinants is the exposure to unhealthy food advertising, especially targeting children. However, Brazilian government regulations have not proven effective in protecting the population from the content of advertising for these foods, while selfregulation has its limitations. Understanding the Brazilian legislative proposals on this topic will make it possible to consider paths to reduce the population's exposure to advertising content on unhealthy foods. Objective: To analyze the content of legislative proposals on food advertising in Brazil. Methodology: This document analysis study was divided into (i) the construction of a glossary with specific terms from the fields of public health, nutrition, advertising, and legislation to provide a terminological framework for the analysis, and (ii) the collection, organization, and compilation of a text database, allowing for quantitative and qualitative analyses of legislative proposals on food advertising. Three types of analysis were used: Descendant Hierarchical Classification, Confirmatory Factor Analysis, and Similarity Analysis, with the assistance of the software IRAMUTEQ. The text database was organized based on data collected from the website of the National Congress, using the search terms "food marketing," "food advertising," "food promotion," "commercial communication," and "food disclosure." Results: A glossary was produced with 29 terms to clarify concepts related to the regulation of food advertising in the national territory. The text database consisted of 19 relevant results. The analyzed proposals are approximately 20 years old, with the majority of initiatives coming from the Chamber of Deputies. Six of the proposals establish updates to Decree-Law No. 986/1969. Among the most significant texts, there is a proposed constitutional amendment that would include food and beverages in the list of products subject to regulations on commercial advertising, as well as four similar proposals that address advertising regulation broadly. Only two proposals are currently under consideration. During the textual analysis, four major thematic classes were identified: Health (37.3% of the analyzed corpus), Regulation (35.4%), Commercial Aspect (12.9%), and Nutritional Content (14.5%). The Health class corresponds to words related to symptoms of a population associated with the consumption of unhealthy foods. The Regulation class contains words referring to legislative regulation on advertising. The Commercial Aspect class includes words related to commercial aspects of foods (e.g., labeling, additives, flavor). The Nutritional Content class presents terms related to nutritional information of foods. Confirmatory factor analysis supported the distribution of words into these four thematic classes. The similarity analysis identified five main branches from the central word "food," which are related to legislation, advertising, children as the target audience, obesity, and fat/trans/saturated/sodium. Conclusion: The analyses indicate that the proposals align with global trends regarding obesity prevention measures. However, project processing is slow and complex, and it faces interference from economic sectors.

Vagalumes e biografemas: poéticas e políticas públicas no desligamento institucional por maioridade / Fireflies and biographems: poetics and public policies regarding institutional removal due to adulthood / Luciérnagas y biografemas: poéticas y políticas públicas en desconexión institucional debido a la edad adulta

Este artigo versa sobre o processo de desligamento institucional por maioridade de jovens que residem em serviços de acolhimento. Aposta-se em uma política do sensível para visibilizar os encontros e desencontros que acontecem entre as e os jovens e as políticas públicas brasileiras. Para tanto, realizaram-se encontros com jovens que já haviam passado pelo processo de desligamento e com jovens que logo completariam 18 anos e teriam de sair das instituições de acolhimento. Para tornar visíveis essas existências, investiu-se na escrita de biografemas, inspirados na obra de Roland Barthes. Os conceitos de necropolítica e vidas precárias foram fundamentais para compreender as omissões do Estado no momento do desligamento. Verificou-se que o Estado pode maximizar a precariedade de algumas vidas, especialmente daquelas marcadas por características de raça, gênero e classe culturalmente marginalizados. Contudo, é também o encontro com as políticas públicas que garante melhores condições de vida para alguns, facilitando o acesso à universidade e ao mercado de trabalho. A pesquisa aponta que, diante do abandono, as e os jovens se fazem vagalumes, produzindo luminosidades em meio à escuridão e reivindicando o direito à vida.(AU)

This article discusses the process of institutional removal of young people that reside in foster care institutions for reaching adulthood. It relies on a politics of the sensitive to make visible the encounters and mismatches that take place between young people and Brazilian public policies. To do so, meetings were held with young people who had already experienced the removal process and with young people who would soon turn 18 and would have to leave the host institutions. To make these existences visible, this study invested in the writing of biographems, inspired by the works of Roland Barthes. The concepts of necropolitics and precarious lives were fundamental to understand the omissions of the State at the time of removal. It was also found that the State can maximize the precariousness of some lives, especially those marked by culturally marginalized race, gender, and class characteristics. However, it is also the encounter with public policies that ensures better living conditions for some, facilitating access to the university and the labor market. This research points out that, in the face of abandonment, young people become fireflies, producing luminosity amid the darkness and claiming the right to life.(AU)

Este artículo aborda el proceso de desconexión institucional justificado por la edad adulta de los jóvenes que residen en los servicios de acogida. Utilizamos una política sensible para hacer visibles las reuniones y los desajustes que tienen lugar entre los jóvenes y las políticas públicas brasileñas. Con este fin, se celebraron reuniones con los jóvenes que ya habían pasado por el proceso de desconexión institucional y también con los jóvenes que pronto cumplirían los 18 años y tendrían que abandonar las instituciones de acogida. Para hacer visibles estas existencias, se redactaron biografemas, inspirados en el trabajo de Roland Barthes. Los conceptos de necropolítica y vida precaria fueron fundamentales para comprender las omisiones del Estado en el momento de la desconexión. Se encontró que el Estado puede maximizar la precariedad de algunas vidas, principalmente de aquellas marcadas por características de raza, género y clase culturalmente marginadas. Sin embargo, el encuentro con las políticas también puede garantizar mejores condiciones de vida para algunos, facilitándoles el acceso a la universidad y al mercado laboral. Esta investigación señala que, ante el abandono, los jóvenes se convierten en luciérnagas, produciendo luminosidad en medio de la oscuridad y reclamando el derecho a la vida.(AU)

Processos de reflexividade dos psicólogos do esporte e coaches: um estudo fenomenológico / Reflexivity processes of sport psychologists and coaches: a phenomenological study / Procesos de reflexividad de psicólogos del deporte y coaches: un estudio fenomenológico

O objetivo desta pesquisa é identificar e compreender fenomenologicamente, por meio de relato de Psicólogos de Esporte (PE) e de Coaches, em sua vivência prática, como ocorrem os processos reflexivos em sua atuação, conforme apreendidos a partir de relatos de experiências. O método de investigação escolhido foi a fenomenologia, pois oferece os recursos necessários para tal mergulho junto à experiência reflexiva. A amostra intencional foi delineada por PE e Coaches (profissionais de Educação Física que recorrem ao Coaching) em atividade em esportes de alto rendimento, que tenham atuado ou estejam atuando em modalidades esportivas coletivas e/ou individuais. Realizaram-se nove entrevistas (cinco com PE, quatro com Coaches). O acesso ao objeto desse estudo se deu por meio de entrevistas em profundidade e semiestruturadas, orientadas pela escuta suspensiva. As questões disparadoras foram formuladas com base no Procedimento Estruturado de Reflexão adaptado. Para análise das entrevistas, realizou-se uma síntese de cada relato, seguindo-se de cruzamento intencional. Como resultados, percebeu-se que PE e Coaches trazem algumas similaridades no que se refere aos modos de refletir sobre sua prática. No entanto, as experiências que eles fazem desses processos reflexivos é que podem tomar rumos distintos. Os(as) PE amparam-se na regulamentação da profissão e resguardam-se em seus apontamentos, trazendo suas experiências e reflexões sobre os processos vividos. Os(as) Coaches trazem em suas explanações um trabalho coerente, organizado e compatível com o método do Coaching. Problematizar os processos reflexivos desses profissionais permite diferenciar qualitativa e eticamente suas atuações, possibilitando o fomento multiprofissional no esporte.(AU)

The aim of this study consists in phenomenologically identifying and understanding, by the report of Sport Psychologists (SP) and coaches, in their practical experience, how would be the reflexive processes that take place in their performance, as learned from reports of their experiences. The research method chosen was phenomenology, since it offers the necessary resources for such a dive along with the reflective experience. The intentional sample was outlined by SP and coaches (Physical Education professionals who use coaching) active in high performance sports, who have or are working in collective and/or individual sports. Nine interviews were conducted (five with SP, four with coaches). Access to the object of this study took place by in-depth and semi-structured interviews, guided by suspensive listening. The triggering questions were formulated based on the adapted Structured Reflection Procedure. For the analysis of the interviews, a synthesis of each report was carried out, followed by the intentional crossing. As results, it was noticed that SP and coaches bring some similarities regarding the ways of reflecting on their practice. However, their experiences of these reflective processes are that they can take different directions. The SP are based on the regulation of the profession and guard themselves in their notes, bringing their experiences and reflections on the processes experienced. Coaches bring in their explanations a coherent, organized, and compatible work with the coaching method. Problematizing the reflective processes of these professionals allows to differentiate their actuation qualitatively and ethically, making the multiprofessional phenomenon in sport possible.(AU)

El objetivo de este estudio consiste en identificar y comprender fenomenológicamente, a partir de la experiencia práctica de psicólogos del deporte (PD) y coaches, cómo serían los procesos reflexivos que se llevan a cabo en su rendimiento, tal y como se desprende de los informes de experiencias. El método de investigación elegido fue la fenomenología, ya que ofrece los recursos necesarios junto con la experiencia. La muestra intencional fue delineada por PD y coaches (profesionales de la educación física que utilizan el coaching) activos en deportes de alto rendimiento, que tienen o están trabajando en deportes colectivos e/o individuales. Se realizaron nueve entrevistas (cinco con PD, cuatro con coaches). El acceso al objeto de este estudio fue entrevistas en profundidad y semiestructuradas, guiadas por escuchas suspensivas. Las preguntas se formularon desde el procedimiento de reflexión estructurado adaptado. Para el análisis de las entrevistas, se hizo una síntesis de cada informe, seguida del cruce intencional. Como resultados, se notó que los PD y coaches tienen algunas similitudes con respecto a las formas de reflexionar sobre su práctica. Sin embargo, las experiencias que hacen de estos procesos pueden tomar diferentes direcciones. Los(las) PD se basan en la regulación de la profesión y se protegen en sus notas, aportando sus experiencias y reflexiones sobre los procesos vividos. Los(las) coaches plantean en sus explicaciones un trabajo coherente, organizado y compatible con el método de Coaching. Problematizar los procesos reflexivos de estos profesionales permite diferenciar sus acciones de manera cualitativa y ética, además de posibilitar la promoción multiprofesional en el deporte.(AU)

Caminhos da participação popular na saúde mental: uma revisão narrativa / Pathways of popular participation in mental health: a narrative review

Resumo A presença de mecanismos de participação popular na saúde mental é fundamental para a democratização. Embora prevista por lei há algumas décadas enquanto diretriz do Sistema Único de Saúde (SUS), a implementação de tais mecanismos é um processo inacabado e complexo, cujos avanços têm sofrido um desmantelamento sistemático em virtude de políticas neoliberais. Este artigo faz uma breve análise histórica desse processo, tendo em vista a construção da reforma psiquiátrica brasileira e, em seguida, apresenta os resultados de uma revisão narrativa, baseada em artigos publicados nos últimos 10 anos acerca do tema da participação popular na saúde mental. São tratados, primeiramente, os sentidos comumente atribuídos ao termo "participação" e os tipos de espaços participativos existentes. Mais adiante, abordam-se algumas potencialidades da participação nesses espaços, como a produção de autonomia e o seu caráter formativo na vida política dos usuários, além de algumas dificuldades que se impõem ao seu funcionamento, como a burocratização dos serviços e os vestígios crescentes de um modelo asilar. Por fim, há a indicação de saídas possíveis para resolver esses problemas, como a promoção de mudanças culturais e a articulação entre movimentos e atores sociais, visando ao fortalecimento dos espaços de participação popular.

Abstract The presence of mechanisms for popular participation in mental health is fundamental for the democratization. Although it has been provided for by law as a guideline of the Brazilian National Health System (SUS) for some decades, the implementation of such mechanisms is an unfinished and complex process, whose advances have been systematically dismantled due to neoliberal policies. This article provides a brief historical analysis of this process, considering the construction of the Brazilian psychiatric reform, and then presents the results of a narrative review, based on articles published in the last 10 years about popular participation in mental health. First, the common meanings of "participation" and the existing types of participatory spaces are discussed. Further on, some potentialities of participation in those spaces, such as producing autonomy and its formative character in the political life of users, in addition to some difficulties that are imposed on its functioning, such as the bureaucratization of services and the growing traces of an asylum model, are analyzed. Finally, possible ways out of these problems, such as promoting cultural changes and articulating movements and social actors, aiming at strengthening spaces for popular participation, are indicated.