CENTRO DE ATENÇÃO PSICOSSOCIAL ÁLCOOL E DROGAS (CAPS-ad): A EX-PERIÊNCIA DOS PROFISSIONAIS DE SAÚDE MENTAL NUMA UNIDADE DA BAIXA MOGIANA

O uso abusivo de substâncias psicoativas tem sido objeto de preocupação e alvo de políticas públicas de enfrentamento, praticamente no mundo todo. O reconhecimento de que tal forma de uso acarreta relevantes consequências econômicas, sociais, acadêmicas, familiares e de saúde física e mental, tem levado as autoridades competentes a criar programas que visam a fazer frente à expansão desse fenômeno. No Brasil, após um período em que o tratamento oferecido aos usuários de substâncias era predominantemente asilar, vem ocorrendo mudanças significativas no modelo de atenção a essa população, notadamente com a implantação dos Centros de Atenção Psicossocial Álcool e Drogas, dentro da estrutura do Sistema Único de Saúde SUS. O presente estudo tem por objetivo identificar e analisar a percepção dos pro-fissionais de saúde mental que atuam no CAPS-ad, sobre a pertinência e a eficácia das abor-dagens e técnicas por eles utilizadas no atendimento aos usuários de substâncias psicoativas. Visa também a conhecer a formação acadêmica e complementar desses trabalhadores; a natu-reza das relações profissionais que se estabelecem entre os membros da equipe; os resultados obtidos com o trabalho e o grau de satisfação dos profissionais com esses resultados. Objetiva ainda a identificar a representação que eles fazem desses usuários e o grau de confiança na proposta CAPS-ad. Para a coleta de dados utilizou-se a técnica de entrevistas semi-estruturadas e o tratamento dos dados foi realizado com base na técnica de Análise de Conte-údo de Laurence Bardin. A investigação revelou que os profissionais não têm formação para lidar com dependência química, que a equipe não atua de forma interdisciplinar e que o trata-mento é realizado de forma aleatória e com baixa eficácia. A representação que fazem do usu-ário é a de um indivíduo doente e ou vitimado pelas condições familiares e sócio-econômicas. Constatou-se também que a maioria dos profissionais tem dúvidas quanto à adequação do CAPS-ad como proposta para cuidar dos usuários de álcool e outras drogas.

Milk feeding, solid feeding, and obesity risk:a review of the relationships between early life feeding practices and later adiposity

Childhood obesity is a major health issue with associated ill-health consequences during childhood and into later adolescence and adulthood. Given that eating behaviors are formed during early childhood, it is important to evaluate the relationships between early life feeding practices and later child adiposity. This review describes and evaluates recent literature exploring associations between child weight and the mode of milk feeding, the age of introducing solid foods and caregivers’ solid feeding practices. There are many inconsistencies in the literature linking early life feeding to later obesity risk and discrepancies may be related to inconsistent definitions, or a lack of control for confounding variables. This review summarizes the literature in this area and identifies the need for large scale longitudinal studies to effectively explore how early life feeding experiences may interact with each other and with nutritional provision during later childhood to predict obesity risk.

Risk factors for type 2 diabetes mellitus and cardiovascular diseases in Hispanic adolescents

This cross-sectional study evaluated risk factors (RF) for type 2 diabetes (T2DM) and cardiovascular diseases (CVD) in 100 Hispanic adolescents(50 overweight, 50 non-overweight) aged 12-16 years, and their associations with body mass index (BMI), diet, physical activity (PA), gender, and birth weight (BW). The RF studied were fasting plasma glucose (FPG), insulin sensitivity (IS), total cholesterol (TC), triacylglycerols (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), acanthosis nigricans (AN), and blood pressure (BP). Dietary intakes were assessed using the Block Kids Questionnaire, fat-related intake behavior (FB) using the Fat-Related Diet Habits Questionnaire, and PA using the Modifiable Activity Questionnaire for Adolescents. Blood was collected after an overnight fast of 12 hours. All statistical analyses used SPSS 14.0. Overweight adolescents had presence of AN, higher BP, TC, TG, and LDL, and lower IS, ps < .001, as compared to non-overweight adolescents. Overweight adolescents were more likely to have 1 and 2 RF for T2DM and CVD as compared to having 0, ps < .001, and 2 RF as compared to having 1, p =.033. Adolescents with kilocalorie (Kcal) intake above requirements for age gender, and PA level were 4.6 times more likely to be overweight, p = .005. Overweight adolescents had worse FB, p = .011, and lower PA, p < .001. Adolescents with worse FB had higher BP, p = .016. Fiber below recommendations (14g/1,000 Kcal) was associated with being overweight, p = .012, and lower IS, p = .040. Adolescents with higher BW had higher FPG, p = .013. Our findings point to an association between being overweight and RF for T2DM and CVD, suggesting that overweight during adolescence may have serious health consequences for Hispanic adolescents. Also, our results indicate that Hispanic overweight adolescents eat more Kcal and less fiber than required, have worst FB, and less PA levels than their non-overweight counterparts. In addition, high BW and dietary habits of Hispanic adolescents, such as low fiber and FB, increase their risk for T2DM and CVD. We conclude that BMI can serve as a useful tool to identify Hispanic adolescents at risk for T2DM and CVD.

Relationships among dietary intake, dietary patterns, dietary quality and nutrient adequacy and substance use in Latina mother/daughter dyads

This study examined the relationships among dietary intake, substance use, socioeconomic and acculturation-related factors among Latinas in Miami-Dade County. Substance abuse is rising among Latinas. A fuller understanding of this problem is needed given the rise of the Hispanic population and the role of women in Latin society. A better understanding between substance use and dietary intake can guide nutrition interventions to reduce negative substance-related health consequences. A purposeful sample of 320 Latina mother/daughter dyads were recruited and interviewed face-to-face as part of the Latino Women's Study. Dietary intake was collected via a 24-hour recall and examined by (1) nutrient intake, (2) dietary patterns using cluster analysis, (3) quality of diet using the Healthy Eating Index (HEI) and (4) the Dietary Reference Intakes to determine nutrient adequacy. Substance use was measured with the Drug Use Frequency and the Healthy and Daily Living Form. Acculturation was measured with the Cultural Identity Scale. Three dietary patterns emerged based on the number of servings from the food groups established in MyPyramid. None were associated with substance use. Latinas who reported using cannabis, cocaine, sedatives without prescription and/or more than five alcoholic drinks on an occasion at least once a month during the previous twelve months had significantly lower HEI scores (64 vs. 60; F = 7.8, p = .005) and consumed fewer fruits (F = 16, p < .001) than non-users. Latinas classified as mothers whom reported consuming cannabis at least 1-7 times a week had significantly lower HEI scores (F = 4.23, p = .015, η2 = .027) than daughters with the same frequency of substance use. One dimension of acculturation, greater familiarity with Latin culture, was associated with good dietary quality (β = .142, p = .012) regardless of any type of substance used or income level. There was a high prevalence of inadequacy of folic acid intake (50-75%) regardless of substance use. Substance users consumed significantly more energy (1,798 vs. 1,615; p = .027) than non-users. Although effect sizes were small, associations between dietary intake and substance use among Latinas deserve further exploration while acknowledging the combined association with acculturation. ^

Risk Factors for Maternal Vitamin D Deficiency within the United Arab Emirates

Introduction: Vitamin D deficiency during pregnancy is a public health problem and it has been associated with negative pregnancy outcomes for both mothers and infants. Aim: To estimate the prevalence of vitamin D deficiency in pregnant women in the United Arab Emirates (UAE) and to identify the contribution of risk factors to the 25(OH)D levels. Methods: It is a cross-sectional study in which vitamin D levels of 1088 adult pregnant women were assessed. Information on vitamin D intake was available in a sub-sample of 266 women. Results: The mean serum 25(OH)D was 26.2 nmol/L (95% CI 25.2-27.1 range 5-129.1 nmol/L) with 69% of women being vitamin D deficient (<30 nmol/L). In the bivariate analysis, showed that no predictors could have been indicated as no values exceeded significance (p<0.2). Stepwise multiple linear regression analysis could not be applied to identify predictors of vitamin D levels as no values exceeded p=0.2. Conclusion: Due to the high prevalence of vitamin deficiency in UAE, there is an urge for interventions focusing on supplementation, fortification and diet diversity for preventing health consequences during a critical period of development.

‘We report the world as it is, not as we want it to be’: Journalistic negotiation of news routines, roles and responsibilities when reporting on suicide

Thesis (Master's)--University of Washington, 2016-08

A systematic review of methods to assess intake of sugar-sweetened beverages among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study

Research indicates that intake of sugar-sweetened beverages (SSB) may be associated with negative health consequences. However, differences between assessment methods can affect the comparability of intake data across studies. The current review aimed to identify methods used to assess SSB intake among children and adults in pan-European studies and to inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies. A literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed SSB consumption were included in the review. Studies involving two or more European countries were included in the review. Healthy, free-living children and adults. The review identified twenty-three pan-European studies which assessed intake of SSB. The FFQ was the most commonly used (n 24), followed by the 24 h recall (n 6) and diet records (n 1). There were several differences between the identified FFQ, including the definition of SSB used. In total, seven instruments that were tested for validity were selected as potentially suitable to assess SSB intake among adults (n 1), adolescents (n 3) and children (n 3). The current review highlights the need for instruments to use an agreed definition of SSB. Methods that were tested for validity and used in pan-European populations encompassing a range of countries were identified. These methods should be considered for use by future studies focused on evaluating consumption of SSB.

Impacto das características e condições de trabalho no absentismo em assistentes operacionais de escolas e jardins de infância

O trabalho é capaz de proporcionar sentimentos de identificação, permitindo a partilha de experiências, a aquisição de status social e identidade profissional, mas também pode colocar o trabalhador em situações desagradáveis. As condições a que os trabalhadores estão expostos no seu trabalho e os constrangimentos organizacionais podem despoletar riscos para a sua saúde mental, social e física. A exposição a riscos psicossociais no trabalho tem consequências para a saúde dos trabalhadores. Riscos estes que estão relacionados com a organização do trabalho, com o conteúdo das tarefas e com o ambiente vivenciado no local de trabalho. Para além de consequências para a saúde, a exposição a fatores de risco pode ter consequências que prejudicam o trabalhador, a organização e a sociedade em geral, exemplo dessa consequência é o absentismo. O absentismo é caracterizado pela ausência do trabalhador ao seu local de trabalho, podendo ter na sua essência múltiplas causas, sendo, por sua vez, causador de diversos problemas. A insatisfação com as condições e características do trabalho e os problemas de saúde causados e agravados pela exposição aos riscos leva ao elevado absentismo. Esta dissertação tem como intuito compreender a perceção dos assistentes operacionais acerca da exposição a fatores de riscos psicossociais, compreender a que se deve o elevado índice de absentismo laboral e perceber se existe relação entre este e as condições de trabalho e a perceção de exposição a riscos psicossociais. Participaram do estudo 85 assistentes operacionais, entre os 32 e os 65 anos, de escolas e jardins de infância do conselho. A recolha de dados foi realizada através do questionário INSAT2013 e pela técnica de observação não sistematizada, onde se procurou observar, com o intuito de compreender, as atividades, comportamentos, dificuldades, interações/relações e satisfação do trabalhador assistente operacional. Os principais resultados apresentam uma percepção moderada, por parte dos trabalhadores a riscos psicossociais de modo geral e a sua relação com o elevado absentismo. Umas das conclusões que se destaca na dissertação é que a elevada carga de trabalho reforçada com a redução de colaboradores levam ao aumento do absentismo.

Are iron oxide nanoparticles safe? Current knowledge and future perspectives

Due to their unique physicochemical properties, including superparamagnetism, iron oxide nanoparticles (ION) have a number of interesting applications, especially in the biomedical field, that make them one of the most fascinating nanomaterials. They are used as contrast agents for magnetic resonance imaging, in targeted drug delivery, and for induced hyperthermia cancer treatments. Together with these valuable uses, concerns regarding the onset of unexpected adverse health effects following exposure have been also raised. Nevertheless, despite the numerous ION purposes being explored, currently available information on their potential toxicity is still scarce and controversial data have been reported. Although ION have traditionally been considered as biocompatible - mainly on the basis of viability tests results - influence of nanoparticle surface coating, size, or dose, and of other experimental factors such as treatment time or cell type, has been demonstrated to be important for ION in vitro toxicity manifestation. In vivo studies have shown distribution of ION to different tissues and organs, including brain after passing the blood-brain barrier; nevertheless results from acute toxicity, genotoxicity, immunotoxicity, neurotoxicity and reproductive toxicity investigations in different animal models do not provide a clear overview on ION safety yet, and epidemiological studies are almost inexistent. Much work has still to be done to fully understand how these nanomaterials interact with cellular systems and what, if any, potential adverse health consequences can derive from ION exposure.

Indoor air quality in Portuguese schools: levels and sources of pollutants

Indoor air quality (IAQ) parameters in 73 primary classrooms in Porto were examined for the purpose of assessing levels of volatile organic compounds (VOCs), aldehydes, particulate matter, ventilation rates and bioaerosols within and between schools, and potential sources. Levels of VOCs, aldehydes, PM2.5 , PM10 , bacteria and fungi, carbon dioxide (CO2 ), carbon monoxide, temperature and relative humidity were measured indoors and outdoors and a walkthrough survey was performed concurrently. Ventilation rates were derived from CO2 and occupancy data. Concentrations of CO2 exceeding 1000 ppm were often encountered, indicating poor ventilation. Most VOCs had low concentrations (median of individual species <5 μg/m(3) ) and were below the respective WHO guidelines. Concentrations of particulate matter and culturable bacteria were frequently higher than guidelines/reference values. The variability of VOCs, aldehydes, bioaerosol concentrations, and CO2 levels between schools exceeded the variability within schools. These findings indicate that IAQ problems may persist in classrooms where pollutant sources exist and classrooms are poorly ventilated; source control strategies (related to building location, occupant behavior, maintenance/cleaning activities) are deemed to be the most reliable for the prevention of adverse health consequences in children in schools.

Effect of vitamin D supplementation on bone status, glucose homeostasis and immune function in children with vitamin D deficiency

Background: Between 1961-1971 vitamin D deficiency was recognized as a public health issue in the UK, because of the lack of effective sunlight and the population mix [1, 2]. In recent years, health care professionals have cited evidence suggesting a re-emergence of the vitamin D deficiency linked to a number of health consequences as a concern [3-6]. Evidence from observational studies has linked low vitamin D status with impairment in glucose homeostasis and immune dysfunction [7-9]. However, interventional studies, particularly those focused on paediatric populations, have been limited and inconsistent. There is a need for detailed studies, to clarify the therapeutic benefits of vitamin D in these important clinical areas. Objective: The aims of this PhD thesis were two-fold. Firstly, to perform preliminary work assessing the association between vitamin D deficiency and bone status, glucose homeostasis and immune function, and to explore any changes in these parameters following short term vitamin D3 replacement therapy. Secondly, to assess the effectiveness of an electronic surveillance system (ScotPSU) as a tool to determine the current incidence of hospital-based presentation of childhood vitamin D deficiency in Scotland. Methods: Active surveillance was performed for a period of two years as a part of an electronic web-based surveillance programme performed by the Scottish Paediatric Surveillance Unit (ScotPSU). The validity of the system was assessed by identifying cases with profound vitamin D deficiency (in Glasgow and Edinburgh) from the regional laboratory. All clinical details were checked against those identified using the surveillance system. Thirty-seven children aged 3 months to 10 years, who had been diagnosed with vitamin D deficiency, were recruited for the bone, glucose and immunity studies over a period of 24 months. Twenty-five samples were analysed for the glucose and bone studies; of these, 18 samples were further analysed for immune study. Treatment consisted of six weeks taking 5000 IU units cholecalciferol orally once a day. At baseline and after completion of treatment, 25 hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), alkaline phosphatase (ALP), collagen type 1 cross-linked C-telopeptide (CTX), osteocalcin (OCN), calcium, phosphate, insulin, glucose, homeostasis model assessment index, estimated insulin resistance (HOMA IR), glycated hemoglobin (HbA1c), sex hormone binding globulin (SHBG), lipids profiles, T helper 1 (Th1) cytokines (interleukin-2 ( IL-2), tumor necrosis factors-alpha (TNF-α), interferon-gamma (INF-γ)), T helper 2 (Th2) cytokines (interleukin-4 (IL-4), interleukin-5 (IL-5), interleukin-6 (IL-6)), T helper 17 (Th17) cytokine (interleukin-17 (IL-17)), Regulatory T (Treg) cytokine (interleukin-10 (IL-10)) and chemokines/cytokines, linked with Th1/Th2 subset balance and/or differentiation (interleukin-8 (IL-8), interleukin-12 (IL-12), eosinophil chemotactic protein ( EOTAXIN), macrophage inflammatory proteins-1beta (MIP-1β), interferon-gamma-induced protein-10 (IP-10), regulated on activation, normal T cell expressed and secreted (RANTES), monocyte chemoattractant protein-1(MCP-1)) were measured. Leukoocyte subset analysis was performed for T cells, B cells and T regulatory cells and a luminex assay was used to measure the cytokiens. Results: Between September 2009 and August 2011, 163 cases of vitamin D deficiency were brought to the attention of the ScotPSU, and the majority of cases (n = 82) were reported in Glasgow. The cross-validation checking in Glasgow and Edinburgh over a one-year period revealed only 3 (11%) cases of clearly symptomatic vitamin D deficiency, which had been missed by the ScotPSU survey in Glasgow. While 16 (67%) symptomatic cases had failed to be reported through the ScotPSU survey in Edinburgh. For the 23 children who are included in bone and glucose studies, 22 (96%) children had basal serum 25(OH)D in the deficiency range (< 50 nmol/l) and one (4%) child had serum 25(OH)D in the insufficiency range (51-75 nmol/l). Following vitamin D3 treatment, 2 (9%) children had final serum 25(OH)D lower than 50 nmol/l, 6 (26%) children had final serum 25(OH)D between >50-75 nmol/l, 12 (52%) children reached a final serum 25(OH)D >75-150 nmol/l and finally 3 (13%) exceeded the normal reference range with a final 25(OH)D >150 nmol/l. Markers for remodelling ALP and PTH had significantly decreased (p = 0.001 and <0.0001 for ALP and PTH respectively). In 17 patients for whom insulin and HOMA IR data were available and enrolled in glucose study, significant improvements in insulin resistance (p = 0.04) with a trend toward a reduction in serum insulin (p = 0.05) was observed. Of those 14 children who had their cytokines profile data analysed and enrolled in the immunity study, insulin and HOMA IR data were missed in one child. A significant increase in the main Th2 secreted cytokine IL-4 (p = 0.001) and a tendency for significant increases in other Th2 secreted cytokines IL-5 (p = 0.05) and IL-6 (p = 0.05) was observed following vitamin D3 supplementation. Conclusion: An electronic surveillance system can provide data for studying the epidemiology of vitamin D deficiency. However, it may underestimate the number of positive cases. Improving vitamin D status in vitamin D deficient otherwise healthy children significantly improved their vitamin D deficient status, and was associated with an improvement in bone profile, improvements in insulin resistance and an alteration in main Th2 secreting cytokines.

Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P)

International audience

COMMUNITY KNOWLEDGE, ATTITUDE AND PRACTICES (KAP) ON FLUOROSIS AND ITS MITIGATION IN ENDEMIC AREAS OF ETHIOPIA

Optimum fluoride intake plays an essential role in the prevention of dental caries while fluoride consumption above recommended level interferes with the normal formation of tooth enamel and bones and may increase risk of dental and skeletal fluorosis. The knowledge and practices of endemic communities on etiology of fluorosis will help in its mitigation and prevention. The objective of this study was to investigate the knowledge, attitude and practices of endemic community on fluoride contamination, fluorosis and prevention practices in order to devise coordinated and targeted prevention mechanisms. Focus group discussions (FGD) and key-informant interview were conducted in three dietary areas to collect knowledge, attitude and practices (KAP) of the endemic community in July 2013.The results indicated that health consequences of fluoride contaminated water are fairly understood. None of the discussants mentioned the word “fluoride”. The knowledge and perception of the community on fluoride ingestion is poor. Health extension workers (HEWs) did not teach about fluoride and related health consequences. Dental fluorosis was reported to start at early ages and not commonly perceived as a major problem. However, adolescents worried and felt that they might be singled out when going to other areas. Older people have a skeletal fluorosis, which interferes with their day to day activities. In severely affected people, the teeth were weak and fragile and thus create difficulty in chewing hard foods like unfermented dry flat bread, sugar cane and toasted grains. People prefer rain water rather than water from borehole because of the inconvenient taste of the latter. The endemic communities have no sufficient knowledge and skills on potential sources of fluoride intake, the debilitating effect of high fluoride ingestion, and preventive and mitigatory measures to reduce fluoride intake. The effect of fluoride contamination and mitigatory methods should get sufficient attention by the community, health workers and concerned governmental bodies. The trend of harvesting and using rain water should be encouraged as it reduces fluoride intake. Future studies should focus on information communication on possible fluoride risks, intervention and evaluation studies on defluoridation, rain water harvesting and mitigatory techniques.

Calidad del sueño y rendimiento académico en estudiantes de medicina de la Universidad de Cuenca marzo- agosto 2015

Antecedentes: La mala calidad del sueño en los estudiantes de medicina debido a sus horarios de estudio, turnos, carga académica, estrés emocional y académico, repercute en su salud física y mental. Estudios previos han demostrado la existencia de una relación entre la mala calidad del sueño y un menor rendimiento académico. Objetivo General: Caracterizar la calidad del sueño y su relación con el rendimiento académico en los estudiantes de medicina de la Universidad de Cuenca durante el periodo lectivo Marzo- Agosto 2015. Metodología: Se realizó un estudio transversal a partir de una muestra de 246 estudiantes de medicina seleccionada mediante conglomerados al azar simple. Participaron 244 estudiantes, tras aplicar criterios de exclusión Se utilizó el ICSP para valorar la calidad del sueño y se obtuvo el promedio global de notas del último bimensual. Se buscó relación entre calidad de sueño y rendimiento escolar a través del cálculo de p, OR e IC. Conclusiones: La prevalencia de mala calidad del sueño fue de 66,2%; siendo más frecuente en el sexo femenino (71%). De los estudiantes con un rendimiento académico “Bueno”, el 67% tienen una mala calidad del sueño. Por lo tanto no se encontró una asociación estadísticamente significativa entre la calidad del sueño y el rendimiento académico. Resultados: Se logró obtener una visión general de la prevalencia de la calidad del sueño de los estudiantes de nuestra universidad, y su relación con el rendimiento académico de los mismos. La importancia de este estudio radica en que existen pocos estudios y datos del tema en nuestro país

Estado nutricional y etapas de cambio comportamental frente a la actividad física niños y adolescentes de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: El propósito del estudio fue relacionar la etapa en el cambio en el comportamiento frente a la actividad física y el estado nutricional en escolares entre 9 y 17 años de Bogotá- Colombia, pertenecientes al estudio FUPRECOL. Método: Se trata de un estudio transversal, en 6.606 niños y adolescentes entre 9 y 17 años, pertenecientes a 24 instituciones educativas, de Bogotá-Colombia. Se aplicó de manera auto-diligenciada el cuestionario de cambio de comportamiento en función a la intensión de realizar actividad física (CCC-Fuprecol) y se midió el peso y la estatura para determinar el estado nutricional con el índice de masa corporal (IMC). Resultados: El porcentaje de respuesta fue 94% y se consideraron válidos 6,606 registros, siendo 58.3 % (n=3.850) niñas con un promedio de edad de 12,7±2,3 años. En la población general, el 5,3 % de los escolares se encontraban en etapa de pre-contemplación, 31,8 % en contemplación, el 26,7 % en acción y el 36,2 % en etapa de mantenimiento. Al comparar la etapa de cambio con el estado nutricional por IMC, los escolares clasificados en obesidad mostraron mayor frecuencia de respuesta en la etapa de pre-contemplación, mientras que los escolares con peso saludable acusaron mayores porcentajes en la etapa de mantenimiento. Conclusión: En escolares de Bogotá, Colombia, se encontró una relación estadísticamente significativa entre a la intensión de realizar actividad con el estado nutricional medido con el IMC. Fomentar la promoción de la actividad física y monitorear el estado nutricional, deberá ser una prioridad en las agendas y políticas públicas dentro del ámbito escolar.