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Esta pesquisa investigou narrativas maternas sobre a hospitalização de seus bebês cronicamente adoecidos em uma maternidade pública do município de São Paulo, no ano de 2022, a partir da análise temática de quatro entrevistas semiestruturadas. O material coletado foi discutido em articulação com as contribuições da psicanálise, organizado em três eixos centrais. As mães entrevistadas parecem ter encontrado caminhos possíveis para o exercício da função materna e constituição do laço com seus bebês. Suas experiências foram marcadas por sentimentos ambivalentes e relatos de sofrimento psíquico que demandam cuidados em saúde mental. Buscou-se criar aproximações com a realidade estudada, lançando um olhar para experiências originais de maternagem e para aimportância da construção de dispositivos de cuidado atentos às necessidades das figuras parentais e de seus bebês em contexto de hospitalização e adoecimento

Se investigó narrativas maternas sobre la hospitalización de sus bebés crónicamente enfermos, en una maternidad pública de la ciudad de São Paulo, en el año 2022, desde el análisis temático de cuatro entrevistas semiestructuradas. El material recopilado fue discutido en articulación con los aportes del psicoanálisis, organizado en tres ejes centrales. Las madres entrevistadas parecen haber encontrado posibles formas de ejercer la función materna y construir un vínculo con su bebé. Sus vivencias estuvieron marcadas por sentimientos ambivalentes y relatos de sufrimiento psíquico que demandan atención en salud mental. Se intentó crear aproximaciones con la realidad estudiada, mirando experiencias originales de la maternidad y la importancia de construir dispositivos de cuidado atentos a las necesidades de las figuras parentales y sus bebés en el contexto de hospitalización y enfermedad

This study investigated mothers' narratives about their chronically ill babies' hospitalization at a public maternity hospital in São Paulo, during 2022, based on thematic analysis of four semi-structured interviews. The main qualitative data from interviews were analyzed concerning its psychoanalytic contribution, organized by three central themes. Interviewed mothers seemed to have found possible ways to perform the maternal function and bond with their babies. Their experiences were affected by ambivalent feelings and psychic suffering that demands mental health care. The aim was to come closer to this reality, remarking original motherhood experiences and the importance of developing caregiving practices worried about the needs of parental figures and their babies in the context of hospitalization and illness

Cette recherche étudie les récits maternels sur l'hospitalisation de leurs bébés souffrant de maladie chronique, dans une maternité publique de la ville de São Paulo, en 2022, à partir de l'analyse thématique de quatre entretiens semi-structurés. Le matériel collecté a été discuté en articulation avec les apports de la psychanalyse, organisés en trois axes centraux. Les mères interrogées semblent avoir trouvé des moyens possibles d'exercer la fonction maternelle et de créer un lien avec leur bébé. Leurs expériences ont été marquées par des sentiments ambivalents et des rapports de souffrance psychique qui exigent des soins de santé mentale. Nous avons cherché à créer des rapprochements avec la réalité étudiée, en s'intéressant aux expériences originales de la maternité et à l'importance de construire des dispositifs de soins attentifs aux besoins des figures parentales et de leurs bébés dans le cadre de l'hospitalisation et de la maladie

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Neurofibromatosis is an autosomal dominant disorder characterized by tumors of the nervous system and skin. Plexiform neurofibromas are common complications of neurofibromatosis type 1 and can cause large facial deformities. Vascular anomalies are in turn a rare manifestation of neurofibromatosis. We present the case of a 48-year-old female patient with right hemifacial neurofibromatosis associated with venous vascular malformation, previously treated surgically and then with sclerosing agents, determining severe residual facial deformity. Her surgical approach using a modified facelift technique associated with partial tumor debulking and lipofilling seems to be a valid technical alternative for these highly complex cases that require a customized approach after exhaustive preoperative evaluation.

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OBJECTIVE: Mental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. METHODS: We carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest - low access to psychiatric care - was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. RESULTS: We retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with 'mood disorders', and 17% with 'neurotic, stress-related and somatoform disorders'). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly 'mood disorders', 'neurotic, stress-related and somatoform disorders' and 'personality disorders'. For mood disorders, clinical characteristics of episodes were defined as 'severe' or 'with psychotic symptoms' in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with 'mood disorders' and 'psychotic disorders') and 41% only had care by a general practitioner (mostly subjects with 'neurotic, stress-related and somatoform disorders'). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. CONCLUSION: More than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.

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El artículo examina las nociones de salud y enfermedad elaboradas por los planteamientos de G. Canguilhem. Estas son analizadas tomando en cuenta las hipótesis freudianas relativas a la neurosis, la normalidad y la enfermedad mental. En particular, se aborda el concepto de normatividad en la filosofía de G. Canguilhem, estableciendo un diálogo con las nociones de síntoma y enfermedad en los textos freudianos. En este marco, se da relevancia a la relación entre el síntoma y la fantasía como fenómenos que resaltan la creatividad del ser viviente. Se precisa que esta última se expresa de modo diferenciado en la organización de los cuadros neuróticos y psicóticos. Para finalizar, a través de las ideas expuestas por A. Badiou, se analiza la tensión entre la dimensión objetiva y subjetiva del sujeto, como sustrato lógico de la crítica que puede ser establecida de los procedimientos científico-naturales de la medicina y su afán de objetivación de la experiencia clínica.

O artigo examina as noções de saúde e doença elaboradas pelas abordagens de G. Canguilhem. Elas são analisadas levando-se em conta as hipóteses freudianas sobre neurose, normalidade e doença mental. Em particular, o conceito de normatividade na filosofia de G. Canguilhem é abordado, estabelecendo um diálogo com as noções de sintoma e doença nos textos freudianos. Nessa estrutura, é dada relevância à relação entre sintoma e fantasia como fenômenos que destacam a criatividade do ser vivo. Especifica-se que esta última se expressa de forma diferenciada na organização de quadros neuróticos e psicóticos. Finalmente, por meio das ideias apresentadas por A. Badiou, a tensão entre a dimensão objetiva e subjetiva do sujeito é analisada como um substrato lógico da crítica que pode ser estabelecida aos procedimentos científico-naturais da medicina e sua ânsia de objetivar a experiência clínica.

The article examines the notions of health and illness elaborated by the approaches of G. Canguilhem. These are analyzed addressing Freudian hypotheses concerning neurosis, normality and mental illness. In particular, the concept of normativity in G. Canguilhem's philosophy is approached, establishing a dialogue with the notions of symptom and illness in Freudian texts. In this framework, relevance is given to the relationship between symptom and fantasy as phenomena that highlight the creativity of the living being. It is specified that this creativity is expressed in a differentiated way in the organization of neurotic and psychotic pictures. Finally, through the ideas exposed by A. Badiou, the tension between the objective and subjective dimension of the subject is analyzed as a logical substratum of the critique that can be established of the natural-scientific procedures of medicine and its eagerness to objectify the clinical experience.

L'article examine les notions de santé et de maladie élaborées par les approches de G. Canguilhem. Celles-ci sont analysées en tenant compte des hypothèses freudiennes concernant la névrose, la normalité et la maladie mentale. En particulier, le concept de normativité dans la phi,1tôme et de maladie dans les textes freudiens. Dans ce cadre, l'accent est mis sur la relation entre le symptôme et le fantasme en tant que phénomènes qui mettent en évidence la créativité de l'être vivant. Il est précisé que celle-ci s'exprime de manière différenciée dans l'organisation des tableaux névrotiques et psychotiques. Enfin, à travers les idées avancées par A. Badiou, la tension entre la dimension objective et subjective du sujet est analysée comme un substrat logique de la critique que l'on peut établir des procédures naturelles-scientifiques de la médecine et de son empressement à objectiver l'expérience clinique.

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This was a cross-sectional study with chronic kidney disease (CKD) patients under non-dialysis-dependent (NDD), hemodialysis (HD), and kidney transplant (KTx) treatment aimed to evaluate the prevalence of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation for the National Institutes of Health (FNIH) guidelines, and to analyze the relationship between sarcopenia and its components and body adiposity. Body composition was assessed by dual-energy X-ray absorptiometry and anthropometry. Bioelectrical impedance provided data on the phase angle and body water. The prevalence of sarcopenia in the total sample (n = 243; 53% men, 48 ± 10 years) was 7% according to the FNIH and 5% according to the EWGSOP2 criteria, and was low in each CKD group independently of the criteria applied (maximum 11% prevalence). Low muscle mass was present in 39% (FNIH) and 36% (EWGSOP2) and dynapenia in 10% of the patients. Patients who were sarcopenic according to the EWGSOP2 criteria presented low body adiposity. Conversely, patients who were sarcopenic according to the FNIH criteria presented high adiposity. This study suggests that in CKD (i) sarcopenia and low muscle mass prevalence varies according to the diagnostic criteria; (ii) sarcopenia and low muscle mass are common conditions; (iii) the association with body adiposity depends on the criteria used to define low muscle mass; and (iv) the FNIH criteria detected higher adiposity in individuals with sarcopenia. Novelty: Prevalence of sarcopenia and low muscle mass in CKD varied according to the diagnostic criteria. Association of excess adiposity with sarcopenia and low muscle mass depends on muscle mass index applied. FNIH criteria detected higher adiposity in individuals with sarcopenia and low muscle mass.

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Maintenance of glycemic and lipemic homeostasis can limit the progression of diabetic kidney disease. Resistance training (RT) is effective in controlling glycemia and lipemia in kidney disease; however, the effect of RT with blood flow restriction (RT+BFR) on these metabolic factors has not been investigated. We aimed to verify if chronic (6 months) RT and RT+BFR performed by patients with stage-2 chronic kidney disease (CKD) improves their glycemic homeostasis and immunometabolic profiles. Patients with CKD under conservative treatment (n = 105 (33 females)) from both sexes were randomized into control (n = 35 (11 females); age 57.6 ± 5.2 years), RT (n = 35 (12 females); age 58.0 ± 6.2 years), and RT+BFR (n = 35 (10 females); 58.0 ± 6.4 years) groups. Chronic RT or RT+BFR (6 months) was performed 3 times per week on non-consecutive days with training loading adjusted every 2 months, RT 50%-60%-70% of 1RM, and RT+BFR 30%-40%+50% of 1RM and fixed repetition number. Renal function was estimated with the glomerular filtration rate and serum albumin level. Metabolic, hormonal, and inflammatory assessments were analyzed from blood samples. Six months of RT and RT+BFR were similarly effective in improving glucose homeostasis and hormone mediators of glucose uptake (e.g., irisin, adiponectin, and sirtuin-1), decreasing pro-inflammatory and fibrotic proteins, and attenuating the progression of estimated glomerular filtration rate. Thus, RT+BFR can be considered an additional exercise modality to be included in the treatment of patients with stage 2 chronic kidney disease. Trial registration number: U1111-1237-8231. URL: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w/, no. RBR-3gpg5w. Novelty: Glycemic regulation induced by resistance training prevents the progression of CKD. Chronic RT and RT+BFR promote similar changes in glycemic regulation. RT and RT+BFR can be considered as non-pharmacological tools for the treatment of CKD.

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BACKGROUND: Coronary arterial dominance and myocardial bridges have clinical implications, since a left dominant pattern associated to the presence of myocardial bridges is often associated to a higher incidence of arteriosclerosis and higher mortality by myocardial infarction. OBJECTIVE: To determine the presence and position of myocardial bridges and their relation with coronary arterial dominance. METHODS: Fifty-seven human cadaveric hearts were analyzed into three groups, as follows: right dominance; left dominance; codominance. Each group was then divided into two subgroups: with or without myocardial bridges. Finally, each subgroup with myocardial bridges was classified according to the position of the myocardial bridge according to the main axis of the heart (proximal, middle and distal third). RESULTS: The right dominance occurred in most hearts (30 hearts-52,6%). Twenty-three myocardial bridges (40,3%) were identified and mostly occurred on left dominant hearts (22,8%). The pattern of coronary dominance presented a statistically significant correlation with the presence of myocardial bridges (P=0.048). The middle third of the heart axis showed the highest occurrence of myocardial bridges. CONCLUSION: These findings suggest there is a clear relationship between the presence of myocardial bridges and left dominant pattern. Middle third of the heart axis present the higher occurrence of myocardial bridges. Knowledge of the myocardial bridges morphology is of great clinical significance, improving patient care.

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Resumo Este estudo narra a experiência de uma psicóloga em intervenção interdisciplinar realizada com uma criança hospitalizada com condições crônicas complexas de saúde, diagnosticada com amiotrofia muscular espinhal tipo I. A experiência foi vivenciada em conjunto com a terapia ocupacional e o relato foi estruturado a partir do material clínico registrado em diário de campo pela psicóloga da dupla, durante as sessões semanais ao longo de dois anos de acompanhamento. A experiência trouxe desafios e crescimento pessoal à psicóloga, autora deste estudo, bem como à paciente, por meio de atividades lúdicas adaptadas às suas necessidades, ampliando o cuidado para além da dimensão técnica e tecnológica, que são importantes para a garantia do funcionamento orgânico, embora não suficientes para uma qualidade de vida minimamente satisfatória.

Abstract This study narrates the experience of a psychologist in an interdisciplinary intervention carried out with a hospitalized child with Complex Chronic Conditions, diagnosed with Spinal Muscular Amyotrophy Type I. The intervention took place in conjunction with occupational therapy and the report was structured based on clinical material recorded on the psychologist's fieldnotes, during weekly sessions over two years of monitoring. The experience brought challenges and personal growth to the psychologist, author of this study, as well as to the patient, by means of playful activities adapted to her needs, expanding care beyond the technical and technological dimension-which are important to guarantee organic functioning, although insufficient for a minimally satisfactory quality of life.

Résumé Cette étude raconte l'expérience d'une psychologue dans une intervention interdisciplinaire menée auprès d'un enfant hospitalisé atteint de maladies chroniques complexes, diagnostiqué avec une amyotrophie musculaire spinale de type I. L'intervention a eu lieu en conjonction avec l'ergothérapie et le rapport a été structuré à partir du matériel clinique enregistré par le psychologue dans un journal de terrain, au cours de séances hebdomadaires pendant deux ans de suivi. L'expérience a apporté des défis et une croissance personnelle au psychologue, auteur de cette étude, ainsi qu'à la patiente, par le biais d'activités ludiques adaptées à ses besoins, élargissant les soins au-delà de la dimension technique et technologique-qui sont importantes pour assurer le fonctionnement organique, bien qu'insuffisantes pour une qualité de vie minimalement satisfaisante.

Resumen Este estudio presenta la experiencia de una psicóloga en una intervención interdisciplinaria, realizada con una niña hospitalizada con enfermedades complejas crónicas, específicamente con amiotrofia muscular espinal tipo I. La experiencia se dio junto con la terapia ocupacional, y el relato fue estructurado a partir de material clínico registrado por la psicóloga del dúo en un diario de campo, durante sesiones semanales por dos años de monitoreo. La experiencia trajo desafíos y crecimiento personal a la psicóloga, autora de este estudio, así como a la paciente por medio de actividades lúdicas adaptadas a sus necesidades, lo que amplió la atención más allá de la dimensión técnica y tecnológica, elementos importantes para garantizar el funcionamiento orgánico, pero no suficiente para brindarle una calidad de vida mínimamente satisfactoria.

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BACKGROUND: Apical hypertrophic cardiomyopathy (AHCM) is a rare cardiomyopathy, in which hypertrophy occurs predominantly in the ventricular apex, and in some cases with a high risk of sudden cardiac death. OBJECTIVE: The aim of this paper is to present a case series of patients with AHCM and describe their main clinical, echocardiographic and electrocardiographic characteristics, the recommendation for an implantable cardioverter-defibrillator (ICD) and the frequency of sudden cardiac death (SCD). METHODS: A retrospective case series was conducted at the referral center of a federal teaching hospital, between the years 2005 to 2020, involving patients with an echocardiographic diagnosis of AHCM. The parameters of the American College of Cardiology and the European Society of Cardiology were used to assess the risk of SCD. RESULTS: A total of 11 individuals were assessed with a mean age of 55.3 years, mean follow-up of 41.2 months, most of whom were symptomatic at diagnosis (72.7%). The most frequent symptom was dyspnea (27.3%). A family history of SCD was described in 45.5% of cases. Due to a high risk of SCD, four patients received ICDs. One patient presented sudden cardiac death after having refused the ICD. CONCLUSIONS: Symptoms and alterations in the imaging exams are significant factors in the clinical and prognostic assessment of patients with AHCM.

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Cardiac damage during the acute phase of Chagas disease (CD) is associated with an increase in pro-inflammatory markers and oxidative stress. Melatonin (MEL) has emerged as a promising therapy for CD due to its antioxidant and immunomodulatory properties; however, the protective action of MEL in the cardiac tissue, as well as its direct action on the parasite cycle, is not fully understood. We investigated the effects of MEL on heart parasitism in mice infected with Trypanosoma cruzi and also its effects on the parasitic proliferation in vitro. Our in vivo study showed that MEL reduced circulating parasitemia load, but did not control tissue (heart, liver, and spleen) parasitism in mice. MEL did not prevent the redox imbalance in the left ventricle of infected mice. Our in vitro findings showed that MEL did not inhibit parasites replication within cells, but rather increased their release from cells. MEL did not control parasitism load in the heart or prevent the cardiac redox imbalance induced by acute T. cruzi infection. The hormone controlled the circulating parasitic load, but within cells MEL accelerated parasitic release, a response that can be harmful.

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Resumen Objetivo Evaluar los efectos de una intervención cognitivo conductual vía telefónica sobre la adherencia terapéutica de niños con insuficiencia renal crónica (IRC) y sus cuidadores. Materiales y Métodos El estudio utilizó un diseño de caso único con línea base múltiple. Se aplicó la intervención vía telefónica con dos sesiones presenciales: al principio y al final. Resultados Se observó una tendencia a disminuir el olvido en los medicamentos, reducción del consumo de líquidos con alto contenido de azúcar y un incremento clínicamente significativo en las estrategias de solución de problemas por parte del cuidador. Conclusiones El cuidador percibió beneficios en el niño tales como mayor comprensión de la enfermedad y la importancia de los medicamentos, mayor frecuencia de actitudes positivas del niño hacia los tratamientos orales y mayor autocontrol en el consumo de alimentos y líquidos no saludables. La intervención se distingue por enfocarse en el niño y su cuidador y por aplicarse vía telefónica. La aplicación de un protocolo de intervención facilita que la efectividad del programa no se encuentre directamente relacionada con las habilidades terapéuticas del aplicador. Se recomienda llevar a cabo estudios con mayor cantidad de participantes para evaluar su eficacia.

Abstract Objective Evaluate the effects of a cognitive behavioral intervention by phone on the therapeutic adherence of children with chronic kidney failure (CRF) and their caregivers. Material and Methods The study used a single case design with multiple baseline. The intervention was applied by phone with two face- to-face sessions at the beginning and end. Results There was a tendency to decrease forgetfulness in the medications, reduction of the consumption of liquids with high sugar content and a clinically significant increase in the strategies of solution of problems by the caregiver. Conclusions The caregiver perceived benefits in the child such as greater understanding of the disease and the importance of the medications, more frequent positive attitudes of the child towards oral treatments and greater self-control in them consumption of unhealthy foods and liquids. The intervention is distinguished by focusing on the child and their caregiver and it being applied by telephone. The application of an intervention protocol facilitates that the effectiveness of the program is not directly related to the therapeutic abilities of the applicator. It is recommended to conduct studies with a larger number of participants to evaluate their effectiveness.

Resumo Objetivo Avaliar os efeitos de uma intervenção cognitivo-comportamental via telefone na adesão terapêutica de crianças com insuficiência renal crônica (IRC) e seus cuidadores. Materiais e Métodos O estudo utilizou um design de caso único com múltiplas linhas de base. A intervenção foi aplicada por telefone com duas sessões presenciais: no início e no final. Resultados Houve tendência a diminuir o esquecimento dos medicamentos, a redução no consumo de líquidos com alto teor de açúcar e um aumento clinicamente significativo nas estratégias de solução de problemas por parte do cuidador. Conclusões O cuidador percebeu benefícios na criança, como maior entendimento da doença e importância dos medicamentos, maior frequência de atitudes positivas da criança em relação aos tratamentos orais e maior autocontrole no consumo de alimentos e líquidos não saudáveis. A intervenção é diferenciada, concentrando-se na criança e seu cuidador e aplicando por telefone. A aplicação de um protocolo de intervenção facilita que a eficácia do programa não esteja diretamente relacionada às habilidades terapêuticas do candidato. Recomenda- se a realização de estudos com mais participantes para avaliar sua eficácia.

Résumé Objectif Évaluez les effets de l'intervention cognitive comportementale par téléphone sur l'observance thérapeutique des enfants atteints d'une déficience rénale chronique (MCK) et de leurs soignants. Matériaux et méthodes L'étude a utilisé une seule conception de cas avec une base de référence multiple. L'intervention téléphonique a été appliquée avec deux séances en face-à-face : au début et à la fin. Résultats On a observé une tendance à diminuer l'oubli des médicaments, à réduire la consommation de liquides à teneur élevée en sucre et à augmenter cliniquement considérablement les stratégies de résolution de problèmes des soignants. Conclusions L'aidant percevait des avantages chez l'enfant, comme une meilleure compréhension de la maladie et l'importance des médicaments, une fréquence accrue des attitudes positives de l'enfant à l'égard des traitements oraux et une plus grande maîtrise de soi dans la consommation alimentaire et fluides malsains. L'intervention se distingue en mettant l'accent sur l'enfant et son aidant et en s'appliquant par téléphone. L'application d'un protocole d'intervention facilite le fait que l'efficacité du programme n'est pas directement liée aux compétences thérapeutiques de l'applicateur. Il est recommandé de mener des études avec plus de participants afin d'en évaluer l'efficavacité.

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OBJECTIVE: To analyse spatial patterns and the temporal tendency of mortality related to Chagas disease, in order to identify priority control areas in the state of Sergipe, Northeast Brazil. METHODS: We conducted an ecological and time-series study with spatial analysis techniques on deaths from Chagas disease in the state of Sergipe (1996-2016). We used data from the Mortality Information System (SIM). The temporal analysis was performed using a statistical technique capable of describing changes in the trend pattern for the period. Thematic maps were elaborated from point and polygonal analyses. RESULTS: There were 247 deaths related to Chagas disease, with a mean of 11.7 deaths/year, most of them male (64%), and aged 50-59 years (21%) and 60-69 years (26%). Two segments with increasing, non-constant and significant trends were identified: 1996-2005 (APC = 21.6%; P = 0.01) and 2005-2016 (APC = 4.4%; P = 0.01), with APPC = 11.8% (P = 0.01). A positive and significant spatial autocorrelation with areas of higher risk of death was found in the southern region of the state. CONCLUSIONS: The trend of mortality related to Chagas disease in the state of Sergipe was increasing during the period analysed, with a heterogeneous distribution of cases. A main risk area was identified in the southern region of the state.

OBJECTIF: Analyser les profils spatiaux et la tendance temporelle de la mortalité liée à la maladie de Chagas, afin d'identifier les domaines de priorité de lutte dans l'Etat de Sergipe, dans le nord-est du Brésil. MÉTHODES: Nous avons mené une étude écologique et de séries chronologiques avec des techniques d'analyse spatiale sur les décès dus à la maladie de Chagas dans l'état de Sergipe (1996-2016). Nous avons utilisé les données du système d'information sur la mortalité (SIM). L'analyse temporelle a été réalisée à l'aide d'une technique statistique capable de décrire les changements dans le profil de tendance pour la période. Des cartes thématiques ont été élaborées à partir d'analyses ponctuelles et polygonales. RÉSULTATS: Il y a eu 247 décès liés à la maladie de Chagas, avec une moyenne de 11,7 décès/an, pour la plupart de sexe masculin (64%), et âgés de 50 à 59 ans (21%) et de 60 à 69 ans (26%). Deux segments avec des tendances à la hausse, non constantes et significatives ont été identifiés: 1996-2005 (APC = 21,6%; p = 0,01) et 2005-2016 (APC = 4,4%; p = 0,01), avec APPC = 11,8% (p = 0,01). Une autocorrélation spatiale positive et significative avec des zones à haut risque de décès a été trouvée dans la région sud de l'Etat. CONCLUSIONS: La tendance de la mortalité liée à la maladie de Chagas dans l'état de Sergipe a augmenté au cours de la période analysée , avec une répartition hétérogène des cas. Une principale zone à risque a été identifiée dans la région sud de l'Etat.

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The aim of the present study was to test the hypothesis that inflammation mediates the associations among food intake, clinical-nutritional status, and plasma homocysteine (Hcys) in hemodialysis (HD) subjects. This was a cross-sectional analysis of data on 129 subjects undergoing HD (58.9% male, 61.8 ± 15.5 years of age) from the cohort Nutrition and Genetics on HD outcomes (NUGE-HD study). Sociodemographic, anthropometric, and metabolic data were collected, and food intake was assessed using a quantitative food frequency questionnaire. Plasma C-reactive protein (CRP) was used as an inflammatory marker. Data were analyzed by structural equation modeling. Regarding the direct effects, complex B vitamin intake was negatively associated with body mass index, and diabetes mellitus was positively associated with CRP. Plasma CRP also showed a negative association with Hcys, and the ratio of saturated and polyunsaturated fatty acids intake showed a positive association with Hcys. Regarding indirect effects, the results showed that the relationship between the presence of diabetes mellitus and Hcys is mediated by plasma CRP. In conclusion, the ratio of saturated and polyunsaturated fatty acids had a direct effect on plasma Hcys, whereas inflammation had a direct and mediating effect on the relationship between Hcys and diabetes mellitus in HD subjects. Novelty In end-stage renal disease, CRP influences plasma Hcys directly and also indirectly through its mediating effect. The quantity and quality of dietary fatty acids influence plasma Hcys concentrations in HD subjects.

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OBJECTIVE: To estimate the prevalence of Chagas disease in pregnant women and the vertical transmission of the disease. METHODS: Observational studies were identified from eight electronic databases, and details on study design, population and prevalence of Chagas disease were extracted. The data were pooled using a random-effects model, and choropleth maps were created based on geopolitical regions and countries. RESULTS: The search identified 7788 articles, of which 50 were eligible. We observed a 9% prevalence of Chagas disease among pregnant women in the Americas (95% confidence interval [CI]: 8-10, I2  = 99.96%). High disease prevalence was identified in pregnant women in South American countries (12%, 95% CI: 11-13), while lower values were identified in pregnant women in North America (2%, 95% CI: 1-3). Countries with medium Human Development Index (HDI) had a higher prevalence of Chagas disease in pregnant women (15%, 95% CI: 13-16, I2  = 99.98%) than countries with high HDI (3%, 95% CI: 2-3). The rate of vertical transmission in the continent was 2% (95% CI: 1-2). The statistical analysis showed that this heterogeneity was explained by the study design, region of the Americas and mean income of the country. CONCLUSION: South and Central American countries have a high prevalence and vertical transmission of Chagas disease. Therefore, systematic screens for this disease during the prenatal period are necessary in addition to the diagnosis and treatment of children at risk for Trypanosoma cruzi infection.

OBJECTIF: Estimer la prévalence de la maladie de Chagas chez les femmes enceintes et la transmission verticale de la maladie. MÉTHODES: Des études d'observation ont été identifiées à partir de huit bases de données électroniques et des détails sur la concept de l'étude, la population et la prévalence de la maladie de Chagas ont été extraits. Les données ont été regroupées à l'aide d'un modèle à effets aléatoires et des cartes choroplèthes ont été créées en fonction des régions et des pays géopolitiques. RÉSULTATS: La recherche a identifié 7.788 articles, dont 50 étaient éligibles. Nous avons observé une prévalence de 9% de la maladie de Chagas chez les femmes enceintes dans les Amériques (intervalle de confiance [IC] à 95%: 8-10, I2 = 99,96%). Une prévalence élevée de la maladie a été identifiée chez les femmes enceintes dans les pays d'Amérique du Sud (12%, IC95%: 11-13), tandis que des valeurs plus faibles ont été identifiées chez les femmes enceintes d'Amérique du Nord (2%, IC95%: 1-3). Les pays à indice de développement humain (IDH) moyen présentaient une prévalence plus élevée de la maladie de Chagas chez les femmes enceintes (15%, IC95%: 13-16, I2 = 99,98%) que les pays à IDH élevé (3%, IC95%: 2 -3). Le taux de transmission verticale sur le continent était de 2% (IC95%: 1-2). L'analyse statistique a montré que cette hétérogénéité s'expliquait par le concept d'étude, la région des Amériques et le revenu moyen du pays. CONCLUSION: Les pays d'Amérique du Sud et d'Amérique centrale ont une prévalence élevée et de transmission verticale de la maladie de Chagas. Par conséquent, des dépistages systématiques de cette maladie pendant la période prénatale sont nécessaires en plus du diagnostic et du traitement des enfants à risque d'infection par Trypanosoma cruzi.

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PURPOSE: To describe pre- to post-treatment changes in clinical activity score (CAS) and exophthalmometry in patients with Graves orbitopathy treated with tocilizumab (TCZ). MATERIAL AND METHODS: Eight Mexican patients presenting with active Graves orbitopathy (CAS>3/7) previously treated with glucocorticoids received 1 monthly dose of TCZ for 6 months. CAS, EUGOGO severity assessment and exophthalmometry were used to evaluate clinical status, with serum measurement of thyroid-stimulating hormone receptor antibodies (TR-Ab) for biochemical evaluation before and after application of TCZ. RESULTS: Eight patients were analyzed: 6 male (75%), 2 female (25%): mean age, 45.9±11.2 years; mean weight, 85±18.3 kg. Mean TR-Ab level at treatment outset was 291.9±96.4%, mean CAS 4.1±0.3 and mean exophthalmometry 21.2±3.2 mm. After TCZ treatment, mean TR-Ab level fell to 172.7±54% (P=0.001), mean CAS to 1.1±0.6 (P=0.001) and mean exophthalmometry to 19.3±2 mm (P=0.02). CONCLUSIONS: TCZ is a therapeutic option for glucocorticoid-resistant orbitopathy, and should be considered in second line due to the cost of treatment or in first line in patients with contraindications to intravenous GC pulse therapy.

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OBJECTIVES: There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil. METHODS: Competing risk regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003 and 2014. RESULTS: Among 5614 patients, the rate of CVD was 3.5 (95% confidence interval [95% CI] 2.9-4.3) per 1000 person-years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for ≥55 years vs. <35 years, 95% CI: 2.5-16.3, P < 0.01), black race (aHR 1.8 vs. white race, 95% CI: 1.0-3.1, P = 0.04), past CVD (aHR 3.0 vs. no past CVD, 95% CI: 1.4-6.2, P < 0.01), hypertension (aHR 1.8 vs. no hypertension, 95% CI: 1.0-3.1, P = 0.04), high-grade dyslipidemia (aHR 9.3 vs. no high-grade dyslipidemia, 95% CI: 6.0-14.6, P < 0.01), ever smoking (aHR 2.4 vs. never, 95% CI: 1.2-5.0, P = 0.02) and low nadir CD4 cell count (aHR 1.8 for 100-250 cells/mm3 vs. >250 cells/mm3 , 95% CI: 1.0-3.2, P = 0.05). The rate of death was 16.6 (95% CI: 15.1-18.3) per 1000 person-years. Death was strongly associated with having had a past CVD event (aHR 1.7 vs. no past CVD event, 95% CI: 1.1-2.7, P = 0.01). CONCLUSIONS: Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.

OBJECTIFS: Il existe peu de données sur les maladies cardiovasculaires (MCV) chez les personnes vivant avec le VIH (PVVIH) dans les pays à ressources limitées. Nous avons évalué les facteurs associés aux MCV et l'impact des MCV prévalentes sur la mortalité toutes causes confondues des PVVIH sous le traitement antirétroviral au Brésil. MÉTHODES: Régression des risques concurrente pour évaluer les facteurs associés aux MCV et à la mortalité toutes causes confondues dans l'étude de cohorte VIH-Brésil entre 2003 et 2014. RÉSULTATS: Parmi 5.614 patients, le taux de MCV était de 3,5 (intervalle de confiance à 95% [IC95%] 2,9-4,3) pour 1.000 personnes-années. Les MCV étaient associées à un âge plus avancé (rapport de risque ajusté [aHR] 6,4 chez les ≥55 ans versus chez les <35 ans, IC95%: 2,5-16,3 ; p <0,01), race noire (aHR: 1,8 versus race blanche, IC95%: 1,0-3,1 ; p = 0,04), MCV passée (aHR: 3,0 versus pas de MCV passée, IC95%: 1,4-6,2 ; p <0,01), hypertension (aHR: 1,8 versus pas d'hypertension, IC95%: 1,0-3,1 ; p = 0,04), dyslipidémie de grade élevé (aHR 9,3 versus absence de dyslipidémie de grade élevé, IC95%: 6,0-14,6 ; p <0,01), tabagisme (aHR 2,4 versus n'avoir jamais fumé, IC95%: 1,2-5,0 ; p = 0,02) et faible nombre de CD4 au nadir (aHR: 1,8 pour 100-250 cellules/mm3 versus >250 cellules/mm3 , IC95%: 1,0-3,2 ; p = 0,05). Le taux de décès était de 16,6 (IC95%: 15,1-18,3) pour 1.000 personnes-années. Le décès était fortement associé à un événement MCV antérieur (aHR: 1,7 versus aucun événement MCV antérieur, IC95%: 1,1-2,7 ; p = 0,01). CONCLUSIONS: Les facteurs traditionnels et spécifiques au VIH associés aux MCV chez les PVVIH au Brésil sont similaires à ceux identifiés chez les PVVIH dans les pays à revenu élevé. Les PVVIH au Brésil ayant des antécédents de MCV ont un risque élevé de décès. Les soins et le traitement des MCV restent des priorités pour les PVVIH au Brésil à mesure que cette population vieillit et que l'utilisation des thérapies antirétrovirales augmente.

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Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2- or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the post-revascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure.

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Resumo A demência é uma síndrome de curso lento, progressivo e de natureza crônica, sendo o subtipo doença de Alzheimer (DA) a mais comum. Muitos estudos são realizados a partir das demandas da pessoa com demência, porém na perspectiva do cuidador eles são escassos. A pesquisa qualitativa teve como objetivo conhecer aspectos singulares da experiência do cuidar na perspectiva de cuidadoras familiares de idosos com DA, a partir de abordagem qualitativa. Foi utilizado o método fenomenológico proposto por Giorgi e Sousa. Participaram nove cuidadoras familiares (quatro esposas e cinco filhas) que cuidam de seus familiares. Esta pesquisa acompanhou o cuidar na fase inicial, moderada, avançada, em diferentes estágios da doença e no pós-óbito. A partir da questão central: "Como é para você a experiência de acompanhar seu familiar com a doença de Alzheimer?", emergiram treze unidades temáticas que foram associadas às fases da doença. Os resultados apontaram as necessidades dos cuidadores, que vão desde o diagnóstico em fases iniciais até a criação de espaço para escuta e acolhimento diante das perdas graduais vivenciadas ao longo do processo de cuidar. Assim, é urgente o investimento em formação de profissionais em todas as áreas envolvidas no cuidar para promover qualidade de vida e bem-estar aos cuidadores. bem como a necessidade de equipes interdisciplinares para a experiência singular do cuidado em demência.

Abstract Dementia is a slow-progressing chronic syndrome with the subtype of Alzheimer's disease being the most commom (Burlá, 2015). This study verified the experience of care from the perspective of family caregivers of older adults with AD from the qualitative approach. The phenomenological method proposed by Giorgi and Sousa (2010) was adopted. Nine family caregivers (4 wives and 5 daughters) participated during different stages of the disease and after death. From the main question "How is your experience of caring for your relative with Alzheimer's disease?" emerged 13 thematic units associated with each stage of the disease. The findings raise the need of caregivers, which include initial diagnosis and goes through the creation of a space for listening and care, given the gradual loss experienced throughout the caring process. Thus, there must be investments in forming professionals of all fields related to healthcare in order to promote quality of life and well-being for caregivers, as well as the need for interdisciplinary teams for the unique experience of dementia care.

Résumé La démence est un syndrome à évolution lente et progressive, de nature chronique, et son sous-type la maladie d'Alzheimer étant le plus fréquent (Burlá, 2015). De nombreuses études sont réalisées en fonction des demandes du patient, mais du côté de l'aidant familial, elles sont rares. Cette recherche a eu pour objectif connaître l'expérience des soins du point de vue des aidants familiaux des personnes âgées atteints de la MA à travers une abordage qualitative. En ce qui concerne la méthodologie, nous avons choisi l'approche phénoménologique proposée par Giorgi et Sousa (2010). Y ont participé neuf membres familiaux (4 épouses et 5 filles) qui ont pris part aux soins à différents stades de la maladie et après le décès de leur proche. De la question centrale : « Comment est l'expérience d'accompagner un membre de sa famille avec la maladie d'Alzheimer ? ¼, sont émergé 13 thématiques qui ont été associés aux stades de la maladie. Les résultats ont indiqué le besoin signaler par ces aidants de se faire soutenir à partir de l'accès au diagnostic, en ayant un espace de parole que les soient dédié tout au long du processus de l'accompagnement des soins. Ainsi, il s'avère l'importance d'investissement dans la formation de tous les métiers concernant, pour la qualité de vie et le bien-être des aidants et le besoin d'une équipe interdisciplinaire capable de soutenir l'expérience singulière vécue par le membre de la famille qui s'occupe des soins au patient que souffre de démence.

Resumen La demencia es un síndrome de curso lento y progresivo, de naturaleza crónica, en la cual se destaca como subtipo más común la enfermedad de Alzheimer -EA- (Burlá, 2015). Se han realizado muchos estudios acerca de las demandas del individuo con demencia, pero son pocos desde la perspectiva del cuidador. A partir de un abordaje cualitativo, la investigación tuvo como objetivo conocer la experiencia del cuidado en la perspectiva de cuidadoras familiares de ancianos con EA. Se utilizó el método fenomenológico propuesto por Giorgi y Sousa (2010). Participaron nueve cuidadoras familiares (4 esposas y 5 hijas). El estudio acompañó el proceso del cuidado en las etapas inicial, intermedia y avanzada, en diferentes fases de la enfermedad y en el postóbito. Desde la cuestión central: "Cómo es para usted la experiencia de acompañar a su familiar con la enfermedad de Alzheimer?", emergieron trece unidades temáticas que se asociaron a las fases de la enfermedad. Los hallazgos apuntan las necesidades de los cuidadores, desde el diagnóstico en la etapa inicial hasta la creación de un espacio para la escucha y el acogimiento en el proceso vivenciado a lo largo del cuidado. Es imprescindible invertir en la formación de profesionales de todas las áreas asociadas al cuidado para promover la calidad de vida y el bienestar de los cuidadores, así como son necesarios equipos interdisciplinarios para la experiencia singular del cuidado en demencia.

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Resumen Objetivo: Conocer cómo entraman su vida un grupo de mujeres en situación de pobreza extrema, pertenecientes a tres comunidades de la región del Gran Río Cuarto (Córdoba, Argentina) historias de trabajo, pobreza, salud y enfermedad desde la infancia a la adultez partiendo de sus relatos biográficos desde una investigación psicosociosalubrista y pedagógica. Materiales y métodos: El estudio se realiza con una metodología de investigación cualitativa, interpretativa y crítica. Para la recolección de datos se empleó entrevista a mujeres, desde un criterio de participantes voluntarios. El proceso de análisis cualitativo de datos se llevó a cabo desde la perspectiva diacrónica, procediendo a través del enfoque biográfico narrativo que pemitió considerar la secuencia temporal en los relatos de las entrevistadas, identificando momentos clave en la relación trabajo, salud, enfermedad, infancia y adultez. Se realizó un análisis narrativo categórico, que permitió poner en relación las historias de las distintas mujeres. Resultados: Se realizaron 11 entrevistas a mujeres entre los 22 y 66 años de edad, de cuyo estudio surgieron dos categorías delimitadas a partir de sus testimonios y narrativas: 1: Infancia, trabajo y enfermedad, y 2: Adultez, trabajo y enfermedad. En el análisis de esas categorías se advierte cómo el trabajo ingresa tempranamente a la vida de las mujeres como una exigencia, impuesta en la infancia atravesada por esfuerzos, sufrimientos, dolores físicos y psicoemocionales. La situación no parece mejorar en la adultez, donde el trabajo se intensifica y junto con él sus condiciones de precariedad, la exposicion a riesgos, el cansancio, la debilidad del cuerpo y la posibilidad de enfermar. Conclusiones: El estudio intenta abonar al conocimiento de una realidad compleja para la construcción de alternativas de transformación desde la apuesta por el diseño y ejecución de políticas públicas y sociales, programas y proyectos en ámbitos sociosanitarios.

Abstract Objective: To find out how work, poverty, health, disease from childhood histories and adulthood enter into the life of a group of women in extreme poverty belonging to three communities in the Gran Río Cuarto region (Córdoba, Argentina), taken from their biographical accounts and from psycho-social and pedagogical research. Materials and methods: The study is carried out with a methodology of qualitative, interpretative and critical research. For the data collection interviews were used with women, the sample being formed from a criterion of voluntary participants. The process of qualitative data analysis was carried out from a diachronic perspective, proceeding through a narrative biographical approach that allowed to consider the temporal sequence in the stories of the interviewed, identifying key moments in the relationship between work, health, illness, childhood and adulthood. A categorical narrative analysis was carried out that enabled the dialogue between the different women´s narratives. Results: Eleven interviews were conducted with women between the ages of 22 and 66, from whose study two categories emerged based on their testimonies and narratives: 1. Childhood, work and illness, and 2. Adulthood, work and illness. The analysis of these categories shows how work enters the life of women early, as a requirement imposed in a childhood crossed by efforts, suffering, physical and psycho-emotional pain. The situation does not seem to improve with adulthood where work intensifies and along with it their conditions of precariousness, exposure to risks, fatigue, weakness of the body and the possibility of getting sick. Conclusions: The study tries to pay attention to a complex reality for the construction of transformation alternatives from a commitment to the design and execution of public and social policies, programs and projects in socio-health areas.

Resumo Objetivo: Conhecer como se relacionam as vidas de um grupo de mulheres que vivem na pobreza extrema, a partir de três comunidades do Grande Rio Cuarto (Córdoba, Argentina) no ambito das histórias de trabalho, pobreza, saúde e doença na infância e na idade adulta a partir de seus relatos biográficos da pesquisa psicossocial e pedagógica. Materiais e métodos: O estudo é realizado com uma metodologia de pesquisa qualitativa, interpretativa e crítica. Para a colheita de dados, foram utilizadas entrevistas a mulheres, tendo como critério ser voluntárias. O processo de análise qualitativa dos dados foi realizada a partir de uma perspectiva diacrônica, procedendo através de uma abordagem biográfica narrativa que permitiu considerar a sequência temporal nas histórias das entrevistadas, identificando momentos-chave no trabalho, saúde, doença, relacionamento infância e idade adulta. Foi realizada uma análise narrativa categorial que possibilitou o diálogo entre as diferentes narrativas das mulheres. Resultados: Realizaram-se 11 entrevistas a mulheres entre 22 e 66 anos de idade. Dos relatos emirgiram duas categorias: 1. Infância, trabalho e doença, e 2. Idade adulta, trabalho e doença. Da análise dessas categorias é de notar que o trabalho inicia-se cedo na vida das mulheres, como uma obrigação imposta a uma criança e que acarreta esforço, sofrimento, dor física e psico-emocional. A situação não melhora com a idade adulta, onde o trabalho se torna mais intenso associado a condições precárias, com exposição a riscos, fadiga, debilidade fisica e a possibilidade de adoecer. Conclusões: O estudo tenta prestar atenção a uma realidade complexa de modo a permitir a construção de alternativas de transformação de compromissos, através do planeamento e execução de políticas públicas e sociais, programas e projetos sociosanitários.

Résumé Objectif: Déterminer comment le travail, la pauvreté, la santé et les maladies héritées de l'enfance et l'âge adulte entrent dans la vie d'un groupe de femmes extrêmement pauvres appartenant à trois communautés de la région de Gran Río Cuarto (Córdoba, Argentine), extraites de leurs récits biographiques et de recherches psycho-sociales et pédagogiques. Matériaux et méthodes: L'étude est réalisée selon une méthodologie de recherche qualitative, interprétative et critique. Pour la collecte de données, un entretien avec des femmes a été utilisé, à partir d'un critère de participation volontaire. Le processus d'analyse qualitative des données s'est déroulé selon la perspective diachronique, en suivant l'approche biographique narrative qui a permis de considérer la séquence temporelle dans les récits des femmes interrogées, en identifient les moments clés de la relation entre travail, santé, maladie, enfance et âge adulte. Une analyse narrative catégorique a été réalisée, qui a permis de relater les histoires des différentes femmes. Résultats: Onze entretiens ont été menés avec des femmes âgées de 22 à 66 ans. Deux catégories d'études ont ensuite été établies à partir de leurs témoignages et récits: 1: enfance, travail et maladie, et 2: adulte, travail et maladie. Dans l'analyse de ces catégories, on peut voir que le travail entre tôt dans la vie des femmes comme une exigence, imposé dans l'enfance, traversé par les efforts, la souffrance, la douleur physique et psycho-émotionnelle. La situation ne semble pas s'améliorer à l'âge adulte, où le travail s'intensifie et, parallèlement, ses conditions de précarité, d'exposition aux risques, de fatigue, de faiblesse du corps et de possibilité de maladie. Conclusions: L'étude tente de contribuer à la connaissance d'une réalité complexe pour la construction d'alternatives à la transformation, allant de l'engagement pour la conception et la mise en oeuvre de politiques, programmes et projets publics et sociaux dans les domaines de la protection sociale.

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Este artigo realizou uma investigação teórica acerca das articulações entre o DSM e a lógica classificatória de Simão Bacamarte. O referido manual foi tomado pelo discurso psicopatológico hegemônico no contemporâneo a partir de uma leitura psicanalítica, enquanto a classificação de Bacamarte compõe a obra "O alienista" de Machado de Assis. Apontamos que o lugar que uma sociedade destina aos avessos da razão delimita o espaço da liberdade, revelando as formas de laço social de uma coletividade. A liberdade estaria intimamente relacionada com uma posição política, constatação que admite que se aborde a psicopatologia sob a mesma perspectiva. Depreendemos que se a loucura venceu os muros dos manicômios, ela permanece, mais do que nunca, aprisionada entre os muros do discurso das excessivas classificações, uma vez que neutraliza aquilo que faz o sujeito do inconsciente falar.

This paper reports a theoretical study of the connections between the DSM and the classificatory logic by Simão Bacamarte. The contemporary hegemonic psychopathological discourse of the DSM was taken from the point of view of a psychoanalytic reading, while Bacamarte's classification composes Machado de Assis' work "The alienist". We point out that the space a society allocates to the reverse of reason defines the space of freedom, revealing the forms of the social bond of a collectivity. Thus, freedom is closely related to a political position, a conclusion that allows to approach psychopathology from the same perspective. We find that if madness has been freed from the asylum walls, it remains more than ever trapped within the walls of the discourse of excessive DSM classifications, since that discourse neutralizes what makes the subject of the unconscious speak.

Cet article décrit une enquête théorique sur les rapports entre le DSM et la logique de la classification de Simão Bacamarte. Le DSM, caractérisé par un discours psychopathologique hégémonique contemporain, a été analysé à partir d'une lecture psychanalytique, tandis que la classification de Bacamarte compose l'œuvre littéraire « L'aliéniste ¼ de Machado de Assis. Nous soulignons que la place qu'une société destine aux envers de la raison délimite l'espace de la liberté et révèle les formes de lien social d'une collectivité. La liberté serait étroitement liée à une position politique, constatation qui admet que la psychopathologie soit abordée par la même perspective. Nous observons que si la folie a réussi à s'évader des murs des asiles, elle reste néanmoins emprisonnée par les murs du discours des classifications DSM excessives, étant donné que celuici neutralise ce qui fait parler le sujet de l'inconscient.

Este artículo realizó una investigación teórica acerca las articulaciones entre el DSM y la lógica clasificatoria de Simão Bacamarte. El DSM fue invadido por el discurso psicopatológico hegemónico en lo contemporáneo a partir de una lectura psicoanalítica, mientras que la clasificación de Bacamarte compone la obra "El alienista", de Machado de Assis. Señalamos que el lugar que una sociedad destina a los contrarios de la razón delimita el espacio de la libertad, revelando las formas de lazo social de una colectividad. La libertad estaría íntimamente relacionada con una posición política, constatación que admite que se aborde la psicopatología bajo la misma perspectiva. Comprendimos que, si la locura venció los muros de los manicomios, ella permanece, más que nunca, encarcelada entre los muros del discurso de las excesivas clasificaciones del DSM, una vez que neutraliza lo que hace al sujeto del inconsciente hablar.

Dieser Artikel beschreibt eine theoretische Untersuchung der Verbindungen zwischen dem DSM und der Klassifikationslogik von Simão Bacamarte. Der gegenwärtige hegemoniale psychopathologische Diskurs des DSM wurde unter dem Blickwinkel der Psychoanalyse übernommen, während Bacamarte's Klassifikationen aus Machado de Assis' Werk „O Alienista" („der Irrenarzt") stammt. Wir kommen zum Schluss, dass der Ort, den eine Gesellschaft der Schattenseite der Vernunft zuordnet, den Raum der Freiheit begrenzt und die Formen der sozialen Bindung einer Kollektivität offenbart. Freiheit steht in enger Verbindung mit politischer Position und diese Feststellung lässt zum Schluss kommen, dass die Psychopathologie aus derselben Perspektive angegangen werden kann. Auch wenn der Wahnsinn den Mauern der Anstalten entkommen ist, bleibt er mehr als je zuvor in den Mauern des Diskurses übermäßiger DSM-Klassifikationen gefangen, da dieser neutralisiert, was das Subjekt des Unbewussten zum Sprechen bringt.