O cuidado em saúde mental infantil na perspectiva de profissionais, familiares e crianças

Introdução: A preocupação e a incorporação da problemática da saúde mental infantil nas políticas públicas de saúde são recentes, assim como o desenvolvimento de ações voltadas a esse cuidado. Preconiza-se que essa atenção se proceda a partir de uma rede composta por serviços atuando de modo articulado a outros setores. Objetivo: Analisar os processos e as condições de produção de cuidados em saúde mental de criança na perspectiva do modo psicossocial na Rede de Atenção Psicossocial. Método: Pesquisa qualitativa, com referencial teórico-metodológico oriundo da Análise Institucional, desenvolvida por meio de Observação Participante em (1) espaços de articulação entre serviços de saúde, (2) Unidade Básica de Saúde e (3) Centro de Atenção Psicossocial Infantojuvenil (CAPSi) no município de Mauá, São Paulo. A Observação Participante permitiu reconhecer os procedimentos de cuidados no cotidiano dos serviços. Para aprofundamento da investigação, foram realizados Grupos Focais com profissionais da Estratégia de Saúde da Família e do CAPSi, com familiares de crianças que frequentam o CAPSi e com crianças usuárias do serviço. Os dados foram analisados e interpretados a partir de conceitos advindos da psicanálise winnicottiana, do modo de atenção psicossocial e da análise institucional. Resultados e Discussão: O interesse, o investimento político e o direcionamento das ações e da organização dos serviços, coerentes com a lógica de atenção psicossocial, têm propiciado um terreno fértil para a construção de práticas transformadoras de cuidado em saúde mental. A incorporação desse cuidado na Atenção Básica, ainda que apresente desafios e tensões entre o modelo instituído (departamentalizado em especialidades) e instituinte (saúde mental integrante da saúde geral), levou a mudanças nas ações e concepções dos profissionais. Contudo, o desenvolvimento de ações intersetoriais e a construção de uma rede ampliada de atenção têm sido limitados pela escassez de serviços e profissionais da rede e por diferentes concepções que atravessam o campo. Os participantes da pesquisa expressam visão conflitante em relação à concepção acerca de problemas de saúde mental e das expectativas quanto ao cuidado, sendo observada forte presença de uma cultura psiquiátrica, que se acentua nas falas dos familiares e na articulação com outros serviços, e uma inclinação a favor da atenção psicossocial, mais presente nas expressões dos profissionais. Nos serviços de saúde, há movimentos instituintes que enfatizam a integralidade da atenção, a interdisciplinaridade do cuidado, a multideterminação do processo saúde-doença, alinhados ao modo de atenção psicossocial. O acolhimento, o vínculo, a escuta e a confiança, importantes elementos do cuidado estão presente nas ações dos serviços. As intervenções terapêuticas têm sido desenvolvidas a partir da singularidade dos casos por meio de Projetos Terapêuticos Individuais, embora sejam consideradas aquém das necessidades das crianças, limitações advindas da escassez de profissionais e serviços da rede. Considerações Finais: Embora os serviços de saúde atuem na direção do cuidado alicerçado no modo psicossocial, eles têm atuado de forma pouco articulada com outros setores. A hegemonia da cultura psiquiátrica é um desafio a ser enfrentado. São urgentes ações que possam promover mudanças nessa cultura predominante e no imaginário social no que toca aos problemas de saúde mental e aceitação das diferenças.

Promoção, comunicação e educação em saúde: a prática da acupuntura e da fitoterapia

Esta pesquisa discute a Comunicação em Saúde no contexto das Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS), no que concerne ao tratamento do câncer realizado num hospital público de Campinas. O arcabouço teórico se debruça sobre as diretrizes do ideário da Promoção da Saúde e sobre as discussões da Educação em Saúde, por serem premissas fundamentais para que a Comunicação em Saúde seja participativa e democrática, e que a Comunicação das PIC conquiste maior espaço na Saúde Pública. O objetivo geral foi investigar o processo de comunicação entre profissionais de saúde e usuários do SUS participantes do Projeto de Construção do Cuidado Integrativo (PCCI). A metodologia utilizada foi a qualitativa tendo como instrumentos pesquisa documental e entrevistas semi-estruturadas para a coleta dos dados. Os participantes do estudo foram usuários que fizeram parte do grupo de Acupuntura e de Fitoterapia e usaram práticas complementares ao tratamento convencional do câncer, e também os profissionais de saúde envolvidos no PCCI realizado no Hospital de Clínicas da Universidade Estadual de Campinas (UNICAMP)/SP. Os dados foram analisados por meio da análise temática de conteúdo de Bardin, que permitiu identificar as seguintes categorias: Medo da intervenção, Analgesia como resultado, Continuidade do tratamento, Falta de informação e Divulgação das práticas. Os resultados mostraram que houve dificuldades de comunicação, indicando lacunas importantes em relação à infraestrutura, à falta de divulgação e continuidade do tratamento complementar com as PIC, a falta de valorização da participação popular e estímulo à autonomia como preconiza o ideário da Promoção da Saúde. Concluiu-se que o modelo de saúde vigente, de base biomédica, não tem permitido a participação dos usuários, e, mais ainda, tem dificultado o desenvolvimento da comunicação democrática, humanizada e solidária. O Projeto (PCCI) foi importante em sua execução, uma vez que trouxe resultados positivos com o uso das PIC por melhorar as condições da qualidade de vida dos usuários e ter promovido analgesia, conferido maior disposição e recuperação dos movimentos. Entretanto, o Projeto (PCCI) não teve potencial o suficiente para provocar uma mudança na lógica do tratamento convencional que está hegemonicamente imerso no modelo biomédico, com isso limitando a inserção e a comunicação das PIC na Saúde Pública e dificultando a abertura para o diálogo entre os diferentes saberes. Entende-se que este é um dos principais desafios da Medicina Tradicional e Complementar (MTC).

Esquema de anotación para categorización de citas en bibliografía científica

El análisis de citas bibliográficas que usa variaciones de métodos de conteo provoca deformaciones en la evaluación del impacto. Para enriquecer el cálculo de los factores de impacto se necesita entender el tipo de influencia de los aportes de un investigador sobre el autor que los menciona. Para ello, se requiere realizar análisis de contenido del contexto de las citas que permita obtener su función, polaridad e influencia. El presente artículo trata sobre la definición de un esquema de anotación tendiente a la creación de un corpus de acceso público que sea la base de trabajo colaborativo en este campo, con miras al desarrollo de sistemas que permitan llevar adelante tareas de análisis de contenido con el objetivo planteado.

Los diez artículos más citados de la revista “Nutrición Hospitalaria”

Después de 36 años de publicación ininterrumpida de la revista Nutrición Hospitalaria, hemos recopilado los diez artículos más citados. Se muestra también la relación de los diez artículos con más citas a escala mundial; asimismo se estratifican las citaciones según el idioma, inglés o español, la temática o los años analizados. Nutr. Hosp. es, a nivel mundial, la revista de nutrición ibero-latinoamericana mejor valorada. Por el volumen de artículos publicados, con 369 ítems citables en 2014, Nutr Hosp se sitúa en cuarto lugar de todas las revistas de nutrición. Permitir la publicación de artículos en inglés o hacerlo simultáneamente en castellano y en inglés, así como estar en régimen de “Open Access” sin restricción de ningún tipo en la difusión desde el momento de aparición de los artículos, son probablemente elementos favorecedores de las citas.

An Academic Medical Center's Expansion to the European Union: A Case Study of UPMC's Joint Projects in Italy and Ireland. Pittsburgh Papers on the European Union Vol. 3, June 2014

This case study examines the expansion of the University of Pittsburgh Medical Center (UPMC) to Italy and Ireland in the European Union. The authors use international business theory to help understand why US Academic Medical Centers (AMCs) are beginning to go abroad and, through semistructured interviews with UPMC officials, they examine the market entry issues UPMC faced when expanding to Italy and Ireland. The authors also explain why UPMC’s first successful foreign ventures took place in the European Union. They conclude with comments on several of the strategic issues that AMCs should address if they wish to successfully expand overseas.

Migration and Integration. Common Challenges and Responses from Europe and Asia

With the signing of the ASEAN Framework Agreement for the Integration of Priority Sectors (FA) in 2004, migration and integration issues gained significance on the agenda. Primarily concerned with increasing economic growth, this framework excludes the integration of low and unskilled migrant workers; instead, ASEAN efforts to address migration and integration issues have been limited to Mutual Recognition Agreements for skilled labour and professionals. After an analysis of migration policy in the region, we highlight specific barriers to the integration of labour migrants in two priority sectors – nursing, which is highly regulated by the state, and Information, Communications and Technology (ICT), which is typically selfregulated and privately run. Despite a MRA for nursing allowing registered nurses to practice in another ASEAN country under supervision of local nurses without registering with the host country’s nursing regulatory authority, in practice, there are major barriers to the free movement of nurses within ASEAN in terms of skills recognition, licensure requirements and other protectionist measures. Although regulations governing the inflow of ICT professionals are not as stringent as those for healthcare professionals, private costs associated with job search and gaining foreign employment are higher in the ICT sector, largely due to limited information on international mobility within the industry. Three sets of barriers to greater integration are discussed. First, the economic and political diversity within ASEAN makes integration more problematic than in the European Union. Second, the primary concern with value-adding economic growth means that regional agreements are focused on skilled and professional labour migration only. Third, the “ASEAN way” of doing things – via a strong emphasis on consensus and non-interference with domestic policies – often means that the FA provision for the free movement of labour is usually trumped by domestic policies that do not reflect the same desire for labour integration.

New Pact for Europe: Towards a New Pact for Europe. Second report, October 2014

As the new EU leadership takes office, Europe faces a complex web of economic, political, social and global challenges which require new responses – above all, the need to restore the public’s faith and trust after the years of crisis which have prompted growing dissatisfaction with the Union, with many people now seeing it as part of the problem rather than part of the solution to those challenges. In 2012, a consortium of 11 European foundations initiated by the King Baudouin Foundation and Bertelsmann Stiftung, and supported by the European Policy Centre, decided to launch a project to promote a Europe-wide debate on the future of EU integration: an ambitious participatory initiative whose ultimate goal is to develop realistic reform proposals to shore up a Union hit by multiple storms in recent years, which have left many people questioning its capacity to respond effectively to those challenges. Two years later, we are proud to be able to present the outcome of this endeavour: the result of a joint reflection process involving the public, politicians, policy-makers, business leaders, trade unionists, EU experts, opinion-formers and other civil society representatives in many EU Member States. Obviously, not all the ideas and proposals generated by this process could be included in this report, but we hope that it faithfully reflects the feedback we received in all the debates. The discussions we have had led to the report that you now hold in your hands, which calls for a New Pact for Europe – between EU Member States and between the EU and its citizens – to enhance the Union’s capacity to deliver effective solutions to the many challenges facing Europe, and to do so in a way that benefits all EU countries and groups within society. This report is designed to feed into the on-going discussions about the EU’s future as the new leadership team takes charge, providing what we hope will be seen as a valuable contribution to the debate on how to introduce ambitious while at the same time workable and realistic reforms to make the EU more effective in responding to the challenges we face. We hope that it will be taken up for discussion by the new European Parliament, the new leadership of the European Commission, European Council and European External Action Service, and also by policy-makers in the Member States. And it does not by any means mark the end of the process. The report will be discussed again with policy-makers and stakeholders in a majority of Member States. Their feedback is important to us and will impact the future progress of the initiative.

Afghan Opium and the EU: Fighting the War Economy through Development Cooperation. EU Diplomacy Paper No. 4, 2014

Opium is at the heart of the war economy in Afghanistan, involving a broad range of actors. It generates a sustainable violence cycle and, while international troops withdraw from the country, threatens the Afghan government’s reconstruction efforts. The European Union (EU) plays an important part in the debate on how to deal with this issue. Several counter-narcotics policies have been implemented since 2001 and have mostly failed. This paper looks at these failures and questions the European Union’s ability to help tackle the problem of opium in Afghanistan. It argues that a comprehensive development response, backed by counter-narcotics incentives, could unfasten the spiral of the war economy. It also argues that the EU has developed relevant policies based on poverty alleviation and a structural approach to the opium issue but still lacks the means for action and for donor coordination in order to significantly influence the situation.

Restoring Order in Global Health Governance: Do Metagovernance Norms Affect Interorganizational Convergence? CES Open Forum Series #23, 2014-2015

This paper theorizes about the convergence of international organizations in global health governance, a field of international cooperation that is commonly portrayed as particularly hit by institutional fragmentation. Unlike existing theories on interorganizationalism that have mainly looked to intra- and extraorganizational factors in order to explain why international organizations cooperate with each other in the first place, the paper is interested in the link between causes and systemic effects of interorganizational convergence. The paper begins by defining interorganizational convergence. It then proceeds to discuss why conventional theories on interorganizational- ism fail to explain the aggregate effects of convergence between IOs in global (health) governance which tend to worsen rather than cushion fragmentation — so-called "hypercollective action" (Severino & Ray 2010). In order to remedy this explanatory blind-spot the paper formulates an alternative sociological institutionalist theory on interorganizational convergence that makes two core theoretical propositions: first that emerging norms of metagovernance are a powerful driver behind interorganizational convergence in global health governance, and secondly that IOs are engaged in a fierce meaning-struggle over these norms which results in hypercollective action. In its empirical part, the paper’s core theoretical propositions are corroborated by analyzing discourses and practices of interorganizational convergence in global health. The empirical analysis allows drawing two far-reaching conclusions. On the one hand, interorganizational harmonization has emerged as a largely undisputed norm in global health which has been translated into ever more institutionalized forms of interorganizational cooperation. On the other, discourses and practices of interorganizational harmonization exhibit conflicts over the ordering principles according to which the policies and actions of international organizations with overlapping mandates and missions should be harmonized. In combination, these two empirical findings explain why interorganizational convergence has so far failed to strengthen the global health architecture.

Information Guide: Food Safety

A guide to the European Union's Food Safety policy, with hyperlinks to sources of information within European Sources Online and on external websites.

Europe cannot afford people in bad health - Economics of health and care as a guide for investments. EPC Commentary, 4 July 2016

It is widely accepted that a new way of looking at Europe’s health sector is necessary if we are to maintain universal health coverage. Financial resources are limited, and the sustainability of Europe’s health systems is under threat. Economic growth is slow, health expenditures outpace GDP growth, public budgets are under strain and demographics – with a growing aging population – are putting pressure on the younger tax-paying generations. In an effort to ensure the sustainability of Europe’s health systems, reforms, underpinned by a new understanding of the economic value of health for individuals and society is needed.

Interface de recuperación para catálogos en línea con salidas ordenadas por probable relevancia

Se presenta el desarrollo de una interface de recuperación de información para catálogos en línea de acceso público (plataforma CDS/ISIS), basada en el concepto de similaridad para generar los resultados de una búsqueda ordenados por posible relevancia. Se expresan los fundamentos teóricos involucrados, para luego detallar la forma en que se efectuó su aplicación tecnológica, explícita a nivel de programación. Para finalizar se esbozan los problemas de implementación según el entorno

Using continuous plankton recorder data

The continuous plankton recorder (CPR) survey is the largest multi-decadal plankton monitoring programme in the world. It was initiated in 1931 and by the end of 2004 had counted 207,619 samples and identified 437 phyto- and zoo-plankton taxa throughout the North Atlantic. CPR data are used extensively by the research community and in recent years have been used increasingly to underpin marine management. Here, we take a critical look at how best to use CPR data. We first describe the CPR itself, CPR sampling, and plankton counting procedures. We discuss the spatial and temporal biases in the Survey, summarise environmental data that have not previously been available, and describe the new data access policy. We supply information essential to using CPR data, including descriptions of each CPR taxonomic entity., the idiosyncrasies associated with counting many of the taxa, the logic behind taxonomic changes in the Survey, the semi-quantitative nature of CPR sampling, and recommendations on choosing the spatial and temporal scale of study. This forms the basis for a broader discussion on how to use CPR data for deriving ecologically meaningful indices based on size, functional groups and biomass that can be used to support research and management. This contribution should be useful for plankton ecologists, modellers and policy makers that actively use CPR data. (c) 2005 Elsevier Ltd. All rights reserved.

Spatial aspects of MRSA epidemiology:A case study using stochastic simulation, kernel estimation and SaTScan

The identification of disease clusters in space or space-time is of vital importance for public health policy and action. In the case of methicillin-resistant Staphylococcus aureus (MRSA), it is particularly important to distinguish between community and health care-associated infections, and to identify reservoirs of infection. 832 cases of MRSA in the West Midlands (UK) were tested for clustering and evidence of community transmission, after being geo-located to the centroids of UK unit postcodes (postal areas roughly equivalent to Zip+4 zip code areas). An age-stratified analysis was also carried out at the coarser spatial resolution of UK Census Output Areas. Stochastic simulation and kernel density estimation were combined to identify significant local clusters of MRSA (p<0.025), which were supported by SaTScan spatial and spatio-temporal scan. In order to investigate local sampling effort, a spatial 'random labelling' approach was used, with MRSA as cases and MSSA (methicillin-sensitive S. aureus) as controls. Heavy sampling in general was a response to MRSA outbreaks, which in turn appeared to be associated with medical care environments. The significance of clusters identified by kernel estimation was independently supported by information on the locations and client groups of nursing homes, and by preliminary molecular typing of isolates. In the absence of occupational/ lifestyle data on patients, the assumption was made that an individual's location and consequent risk is adequately represented by their residential postcode. The problems of this assumption are discussed, with recommendations for future data collection.

PIP-DB:the protein isoelectric point database

A protein's isoelectric point or pI corresponds to the solution pH at which its net surface charge is zero. Since the early days of solution biochemistry, the pI has been recorded and reported, and thus literature reports of pI abound. The Protein Isoelectric Point database (PIP-DB) has collected and collated these data to provide an increasingly comprehensive database for comparison and benchmarking purposes. A web application has been developed to warehouse this database and provide public access to this unique resource. PIP-DB is a web-enabled SQL database with an HTML GUI front-end. PIP-DB is fully searchable across a range of properties.