Direito e reprodução

O presente artigo tem como proposta discutir a questão da autonomia reprodutiva no Brasil a partir da legislação vigente entre o final do século XVII e o início do século XX. Focando nos oitocentos devido ao aumento de controle e vigilância sobre o corpo feminino, principalmente em relação ao aborto, pretende-se ampliar o escopo em torno da compreensão sobre a constituição do papel de gênero imposto às mulheres na sociedade, vinculado especialmente à maternidade. Assim, a criminalização do aborto é um aspecto jurídico central que permite observar os desdobramentos sociopolíticos que intensificaram o cerceamento à autonomia reprodutiva das mulheres

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Functional analytical psychotherapy as a treatment of social anxiety disorder

Os Transtornos de Ansiedade são os diagnósticos clínicos que mais frequentemente aparecem em nossa sociedade. Dentre eles, o Transtorno de Ansiedade Social (TAS) é o mais comum e foi o objeto de estudo deste trabalho. O TAS acomete indivíduos desde a sua infância e compromete uma série de atividades sociais, acadêmicas e profissionais, dificultando o estabelecimento de relações interpessoais. O tratamento mais comumente utilizado é a Terapia Cognitiva Comportamental (TCC) aliada ao uso de fármacos, com técnicas de exposição enquanto estratégia principal e que, de acordo com estudos, revelam um índice de evasão da terapia, bem como dificuldade de implementação pelo terapeuta e aumento dos sintomas de ansiedade, devido ao caráter aversivo que a exposição pode ocasionar. Estudos em Psicoterapia Analítica Funcional (FAP) apontaram resultados positivos da FAP para alguns transtornos de ansiedade e levantaram a hipótese de que essa intervenção seria um bom manejo para indivíduos com TAS, uma vez que não foram encontradas pesquisas que avaliassem a FAP enquanto tratamento para a ansiedade social até a finalização deste trabalho. Considerando que indivíduos com TAS tendem a apresentar comportamentos de esquiva de situações que possam ocasionar julgamentos e avaliações negativas e, portanto, dificultar o estabelecimento de vínculos, e que a FAP tem como princípio proporcionar mudanças através da relação terapêutica, o objetivo do presente estudo foi avaliar a eficácia da FAP enquanto tratamento para indivíduos com TAS e analisar os processos de mudança clínica envolvidos na utilização da FAP. A metodologia foi o delineamento experimental de caso único de linha de base múltipla. Os participantes foram uma terapeuta/pesquisadora, três clientes adultos e três aferidores de concordância. A intervenção ocorreu com a introdução da variável independente (FAP) em momentos distintos para cada participante, de acordo com as fases do experimento: linha de base (Fase A) e introdução da FAP (Fase B). Uma sessão de seguimento foi realizada um mês após o término da psicoterapia para cada participante. Foram transcritas e categorizadas cinco sessões de cada fase para cada participante, com o uso do Sistema de Categorização da Psicoterapia Analítica Funcional (FAPRS), buscando encontrar os processos envolvidos nas mudanças clínicas, com ênfase na relação terapêutica. As melhoras dos clientes foram avaliadas e analisadas por meio dos seguintes instrumentos: Outcome Questionnaire (OQ-45), Beck Depression Inventory (BDI), Liebowitz Social Anxiety Scale (LSAS) e Social Phobia Inventory (SPIN). Os resultados apontaram que após a introdução da FAP os comportamentos clinicamente relevantes do tipo problema (CRB1) diminuíram consideravelmente e os comportamentos clinicamente relevantes de melhora (CRB2) aumentaram drasticamente. Os outros instrumentos não apresentaram resultados significativos em relação ao uso da FAP. Assim, este estudo pontua a eficácia da FAP para o tratamento de indivíduos com TAS, bem como do delineamento de linha de base múltipla em pesquisas de prática clínicaAnxiety Disorders are the clinical diagnoses that most appear in our society. Among them, Social Anxiety Disorder (SAD) is the most common and it was the object of study of this research. SAD affects individuals from their infancy and compromises a series of social, academic and professional activities, making it difficult to establish interpersonal relationships. The most commonly used treatment is Cognitive Behavioral Therapy (CBT), allied to the use of drugs, with exposure strategies as the main strategy and which, according to studies, reveal an evasion rate of the therapy, as well as difficulty of implementation by the therapist and increased anxiety symptoms due to the aversive character that the exposure may cause. Studies in Functional Analytical Psychotherapy (FAP) pointed out positive results from FAP for some anxiety disorders and hypothesized that this intervention would be a good management for individuals with SAD, since no research was found to evaluate FAP as a treatment for social anxiety until the end of this work. Considering that individuals with SAD tend to present behaviors that evade situations that may lead to negative judgments and assessments, and thus make it difficult to establish links, and that the FAP has as principle to provide changes through the therapeutic relationship, the objective of the present study was to evaluate the efficacy of FAP as a treatment for individuals with SAD and to analyze the clinical change processes involved in the use of FAP. The methodology was the experimental design of a single multiple baseline case. Participants included a therapist / researcher, three adult clients, and three concordance checkers. The intervention occurred with the introduction of the independent variable (FAP) at different times for each participant, according to the phases of the experiment: baseline (Phase A) and introduction of FAP (Phase B). A follow-up session was held one month after the end of the psychotherapy for each participant. Five sessions of each phase were transcribed and categorized for each participant, using the Categorization System of Functional Analytical Psychotherapy (FAPRS), seeking to find the processes involved in clinical changes, with emphasis on the therapeutic relationship. Clients improvements were evaluated and analyzed using the following instruments: Outcome Questionnaire (OQ-45), Beck Depression Inventory (BDI), Liebowitz Social Anxiety Scale (LSAS) and Social Phobia Inventory (SPIN). The results showed that after the introduction of FAP, clinically relevant behaviors of the problem type (CRB1) decreased considerably and clinically relevant behaviors of improvement (CRB2) increased dramatically. The other instruments did not present significant results regarding the use of FAP. Thus, this study scores the efficacy of FAP for the treatment of individuals with SAD as well as multiple baseline delineation in clinical practice researc