Cortes que viram cartas : ensaios sobre automutilação na clínica psicanalítica

Tese (doutorado) — Universidade de Brasília, Instituto de Psicologia, Programa de Pós-graduação em Psicologia Clínica e Cultura, 2019.Nesta pesquisa, toma-se como objeto de estudo a automutilação – o ato de machucar o próprio corpo deliberadamente através de cortes, queimaduras, auto espancamento, entre outras formas. Os questionamentos que orientam a pesquisa são decorrentes da prática clínica psicanalítica, juntamente com o trabalho institucional com adolescentes em conflito com a lei. Estudos epidemiológicos têm mostrado que os casos de automutilação aumentaram nos últimos anos e costumam surgir na adolescência, podendo durar por um período curto ou se estender pela vida adulta. A partir do trabalho clínico e institucional com sujeitos que se mutilam, esta tese tem como objetivo principal analisar os aspectos subjetivos da automutilação. Percebe-se que a automutilação se apresenta de forma complexa e multifacetada, portanto, trabalha-se com as noções de espectro e de phármakon como chaves de leitura para pensar em como a automutilação faz diferentes funções para diferentes sujeitos. O ato de mutilar-se pode estar inserido numa ordem cultural – em que funciona como sinal de inclusão e pertencimento – e, visto por outra luz, pode significar exclusão, doença ou sofrimento psíquico. No intuito de abordar essas diferentes facetas, foram ensaiadas algumas leituras possíveis, e cada uma delas está construída na forma de um ensaio. O primeiro ensaio, Automutilação: dos rituais culturais aos manuais diagnósticos, apresenta uma revisão da literatura desde as raízes históricas da automutilação até as mudanças mais recentes na categorização dos manuais diagnósticos. O segundo ensaio, Corpo marcado e encarcerado: automutilação em ambientes confinados, aborda a automutilação em ambientes com privação de liberdade e versa sobre a experiência com adolescentes infratores cumprindo medida socioeducativa de internação. Neste contexto, discorre-se sobre a função do ato na adolescência, articulando a automutilação às formulações psicanalíticas sobre as passagens ao ato. No terceiro ensaio, Automutilação, memória e concretude: o corpo como arquivo, faz-se uma discussão sobre as noções de arquivo e memória, visto que um dos discursos mais frequentes é o de que a automutilação seria uma tentativa de transformar uma dor emocional em uma dor física, concreta, marcada no corpo. No quarto ensaio, O sofrimento endereçado: automutilação, corpo e escrita, faz-se aproximações com a escrita e com a literatura, vislumbrando a automutilação como uma forma de escrita no corpo, a partir do momento em que pode ser endereçada a um outro.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).In this research, the object of study is self-harm - the act of deliberately injuring one's own body through cuts, burns, self-beating, among other forms. The questions that guided the research stemmed from the psychoanalytical clinical practice, as well as from institutional work with young offenders. Epidemiological studies have shown that self-harm cases have increased in recent years, usually arising in adolescence and lasting for a short period of time or extending into adulthood. Being inspired by the clinical and institutional work with people who self-harm, this thesis aims to analyze the subjective aspects of self-harm. Since self-harm appears to be a complex and multifaceted issue, we worked with the notions of spectrum and phármakon as keys to think about how self-harm functions differently for different people. The act of harming oneself may be embedded in a cultural order - in which it functions as a sign of inclusion and belonging - while viewed in a different light, it may mean exclusion, illness or psychological distress. In order to address these different facets, we took a few possible ways of addressing this issue, and each way was written in the form of an essay. The first essay, Self-harm: From Cultural Rituals to Diagnostic Manuals, presents a literature review from the historical roots of self-harm to the most recent changes on the categorization in diagnostic manuals. The second essay, Marked and Imprisoned Body: Self-harm in Confined Environments, addresses self-harm in confined environments through the experience of working with young offenders who are serving a sentence in an institution. In this context, we articulate self-harm with the psychoanalytic theory about acting out. In the third essay, Self-Mutilation, Memory and Concreteness: The Body as an Archive, we discuss the notions of archive and memory, since one of the most frequent discourses is that self-harm would be an attempt to transform emotional pain into a physical, concrete pain marked on the body. In the fourth essay, Addressing suffering: self-harm, body and writing, we approach writing and literature, taking self-harm as a form of writing on the body, considering that it can be addressed to someone else

Determination of the naturalness index of gluten-free breads commercialized in brazilian supermarkets/ Determinação do índice de naturalidade dos pães sem glúten comercializados nos supermercados brasileiros

Gluten-free bread is the preference of many consumers who seek to eat healthier and suffer from physiological disorders when consuming products made with wheat, rye, barley and oats. However, there are still no studies that have evaluated the naturalness of this product. The aim of this study was to determine the naturalness index of gluten-free breads from different brands sold on Brazilian store websites. Terms such as “whole gluten-free bread” and “multigrain gluten-free bread” were used. 10 samples of different brands were selected. The brands of gluten-free breads were evaluated according to the scoring criteria from 1 (not natural) to 5 (extremely natural) for each factor and compared to the reference values. Descriptive statistical analyzes of mean, standard deviation, as well as Pearson's correlation index (r) were performed. In general, gluten-free breads had a Natural Index of 3.00 ± 0.55, being classified as moderately natural. This result pointed to the challenges of making more natural gluten-free breads, with the use of less additives and processed ingredients in the formulations, in order to serve a more conscious and selective market in relation to its food choices

Determination and comparison of the naturalness index of multigrane breads commercialized in brazilian supermarkets / Determinação e comparação do índice de naturalidade dos pães multigranadas comercializados nos supermercados brasileiros

Consumers are increasingly demanding transparency in food labeling. This seems to be particularly the case with the naturalness of food. The Food Naturalness Index is composed of four factors, namely, cultivation practices, exemption from additives, exemption from unexpected ingredients and degree of processing. The objective of this work was to determine and compare the naturalness index of multigrain breads sold in Brazilian markets. For that, 24 labels of multigrain breads were selected and evaluated according to the scoring criteria from 1 (not natural) to 5 (extremely natural) for each factor and compared to the reference values. Descriptive statistical analyzes of mean, standard deviation, as well as Pearson's correlation index (r) were performed. In general, the breads were classified as moderately natural, which alerts the food industry to a new profile of products with more natural characteristics, in order to promote acceptance of consumers concerned with health and well-being

The body in pain: self-harm, masochism and drive

Este artigo tem como objetivo discutir a relação entre corpo e dor na psicanálise. Tomamos como objeto de análise a automutilação - o ato de machucar o próprio corpo deliberadamente. A automutilação é uma questão clínica frequente nos consultórios dos psicólogos e psicanalistas, especialmente em clínicas com adolescentes. É um tema abordado pela psiquiatria, pois muitas pessoas que se machucam são encaminhadas para tratamento psiquiátrico, frequentemente medicamentoso. Na psiquiatria, a automutilação é considerada tanto como um sintoma de alguns transtornos mentais quanto um transtorno em si mesmo. Neste artigo, vislumbramos apresentar uma leitura da automutilação em sua relação com os destinos da pulsão e com o conceito de masoquismo desenvolvido por Freud.This article aims to discuss the relation between body and pain in psychoanalysis. We take self-­harm - the act of deliberately injuring one's own body - as object of analysis. Self-­harm is a common clinical matter in psychologists and psychoanalysts' practice, especially in clinic with teenagers. It is a theme addressed by psychiatry, since many people who hurt themselves are sent to psychiatric treatment, often with medication. In psychiatry, self-­harm is considered both as a symptom of some mental disorders and as a disorder itself. In this article, we aim to present a view of self-­harm in its relation to the concept of masochism developed by Freud.En este texto se pretende discutir la relación entre cuerpo y dolor en psicoanálisis. El objeto de análisis es la automutilación -el acto de causar daño al propio cuerpo deliberadamente. La automutilación es una cuestión clínica común en las clínicas de los psicólogos y psicoanalistas, especialmente en la clínica con adolescentes. Es un tema abordado por la psiquiatría, ya que muchas personas que se lastiman son enviadas a tratamiento psiquiátrico, frecuentemente con utilización de medicamentos. En psiquiatría, la automutilación es considerada tanto un síntoma de algunos trastornos mentales como una molestia. En este trabajo vamos a presentar una lectura de automutilación en su relación con la pulsión y con el concepto de masoquismo, desarrollado por Freud

Associação de sarcopenia com desfecho clínico e tempo de internação em idosos hospitalizados / Association of sarcopenia with clinical outcome and length of stay in hospitalized elderl

Introdução: A sarcopenia é uma causa importante de perda da independência e da diminuição da qualidade de vida em pessoas idosas. Objetivo: Avaliar a associação de sarcopenia com desfecho clínico e tempo de internação em idosos hospitalizados. Métodos: Pesquisa com abordagem quantitativa, do tipo longitudinal e prospectiva, com idosos de ambos os sexos, hospitalizados na clínica médica do Hospital Universitário da Paraíba, onde foram coletados dados demográficos, socioeconômicos, clínicos e antropométricos, tais como avaliação da massa muscular e da força muscular obtido através de bioimpedância elétrica e força de preensão palmar, os quais foram utilizados para o diagnóstico de sarcopenia. Na análise estatística utilizou-se pelos testes Qui-quadrado e correlação de Spearman, assumindo um nível de significância (p<0,05).  Resultados: Foram avaliados 51 idosos, havendo uma perda de três pacientes, fazendo parte da pesquisa 48 indivíduos, com idade média de 70,02 ± 7,02 anos, dos quais 56,2% com idade de 60 a 69 e 54,1% do sexo feminino. A maioria não possuía atividade laboral (83,3%), apresentava renda de até 1 salário variáveis: sexo, faixa etária, escolaridade, renda, ocupação, IMC, CB, FPP, IMME com o tempo de internação e não houve associação do diagnóstico de sarcopenia com a perda da FPP e com tempo de internação, internação em UTI e desfecho clínico. Conclusão: Avaliar a associação da sarcopenia com desfecho clínico e tempo de internação em idosos hospitalizados é de extrema importância uma vez que a realização da avaliação durante a internação hospitalar do paciente permitirá realizar um plano de cuidados pautado em suas necessidades

Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016.

BACKGROUND: The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. METHODOLOGY: We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. PRINCIPAL FINDINGS: The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate and YLD decreased by 51% and 31.8% respectively for the same period. For VL, similar profiles for male and female were observed, with YLL and DALY increasing over time; with males presenting slightly higher values. The highest YLL rates were among "under 1-year old" children, which increased 131.2% from 1990 to 2016. Regarding CML, the highest values of YLD and DALY were verified among males, and YLD values showed a similar profile, with rates increasing with age. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. CONCLUSION: The increase of VL burden over the study period might be associated with the difficulties in controlling the disease spread. Information regarding the weight of VL and CML, including the death and disability tolls that they cause, highlights the impact of these neglected diseases on public health and the importance of effective prevention and treatment

Avaliação fisiológica de prematuros na pesagem tradicional e humanizada: estudo quase-experimental

Objetivo: Descrever e comparar os sinais fisiológicos apresentados pelos prematuros na pesagem tradicional e humanizada.Método: Estudo quase-experimental crossover, com amostra de 30 prematuros randomicamente assinalados e alocados no grupo controle (tradicional) e no grupo intervenção (humanizada),no período de março de 2019 a março de 2020, com a coleta de dados gerais, sinais vitais antes e depois dos procedimentos. As análises estatísticas incluíram descrição de frequências relativas e absolutas, medida de tendência central e de dispersão.Resultados: Os prematuros apresentaram menos aumento na frequência cardíaca (53,3%) e respiratória (43%) na verificação da pesagem humanizada do que na tradicional, com 83,3% dos neonatos e 80%,respectivamente.Conclusão: Observou-se que a forma humanizada proporcionou menos instabilidade fisiológica, principalmente nas frequências cardíaca e respiratória, tornando-se necessário estimular discussões sobre a humanização da assistência e realizar essa prática de forma rotineira nas unidades de saúde. Palavras-chave: Recém-nascido prematuro. Peso corporal. Temperatura corporal. Humanização da assistência

Management practices and innovation: a study in digital port of Recife (PE)

This study aims to verify how relations between management practices and innovation practices adopted by companies linked to Digital Port. We obtained 30 valid questionnaires in the research, aiming to identify the relationship between the characteristics of the company and innovation (hypothesis 1), concluding that as companies that report to partners tend not to invest in innovation, suggesting that there may be a short-term concern term with the result of the company. The study also analyzed two other hypotheses, indicating that some traditional managerial practices are associated with the existence of R & D (rejecting hypothesis 2, eg: budget and performance evaluation), and not showing significance between contemporary practices and R & D hypothesis 3). In order to find other proxies for innovation and to verify the difference between traditional and contemporary managerial practices, a factor analysis was used. There was a positive association between the use of more advanced techniques and more permissive people management, rejecting an idea of control restrictions interfering with people management. Additionally, it has been found that flexibilisation of non-ethical employees' hours is a practice that is innovative and is not usually practiced even by those companies that say they are more innovative

Effects of public health emergencies of international concern on disease control: a systematic review.

OBJECTIVES: To assess the accumulated knowledge of the effects of public health emergencies of international concern on disease control and local health systems, and contribute to a better understanding of their effects on health programs and systems. METHODS: This was a systematic review of published and gray literature (in English, Portuguese, or Spanish). Electronic databases (BVS/LILACS, PubMed, and SciELO) and Google Scholar were searched. Search terms were: COVID-19 OR H1N1 OR Ebola OR Zika OR poliomyelitis AND (outbreaks OR epidemics) AND (public health systems OR public health surveillance). RESULTS: A total of 3 508 studies were retrieved, of which 31 met the inclusion criteria. The studies addressed the effects of the emergencies on: communicable diseases notification systems; malaria, HIV/AIDS, tuberculosis, poliomyelitis, and malaria surveillance, control, and treatment; microcephaly; dengue; and vaccinations. The populations affected by the emergencies experienced reduced health services, which included fewer health visits, failures in the diagnostic chain, decrease in vaccination, and increased incidence or underreporting of notifiable diseases. CONCLUSIONS: Socioeconomic inequity is a determinant of the effects of public health emergencies of international concern within affected populations. The diversion of resources and attention from health authorities disproportionately affects vulnerable populations and can lead, over time, to a weakening of health systems. The analysis of the effects of public health emergencies is important for the development of new protocols that can better respond to future crises