EVOLUÇÃO DO SISTEMA DE AVALIAÇÃO DE IMPACTO AMBIENTAL NO BRASIL COM ÊNFASE NO ESTADO DE SÃO PAULO

A Avaliação de Impacto Ambiental (AIA) tem sido vista como um instrumento de planejamento, isto é, como um instrumento de prevenção do dano ambiental. Para cumprir essa função, é organizada uma série de atividades sequenciais que se dá o nome de processo de avaliação de impacto ambiental. No Brasil, a AIA está associada ao licenciamento ambiental, servindo como suporte para a emissão das licenças ambientais de empreendimentos com potencial risco de causar impacto ambiental. Apesar da prática da AIA estar sendo realizada há mais de 50 anos em âmbito mundial, trazendo muitos benefícios em seu processo, possui muitas críticas quanto à efetividade de seus procedimentos. Este trabalho examinou o progresso da AIA e sua eficácia no Brasil, com ênfase no Estado de São Paulo. A pesquisa foi exploratória bibliográfica e documental, expondo a evolução do processo do licenciamento com a AIA até os dias atuais, apresentando os principais pontos positivos e negativos das modificações feitas nas resoluções regidas pelo país

Contexto de vida de pessoas usuárias de drogas na perspectiva de gênero

Objetivo: Caracterizar o contexto de vida e vulnerabilidade de pessoas usuárias de drogas na perspectiva do gênero. Método: Estudo transversal exploratório com 505 usuários de drogas. Foram consideradas as variáveis: sexo, perfil socioeconômico e eventos ocorridos no último ano. Resultados: Observa-se que mulheres usuárias de drogas, mesmo em menor número do que os homens, apresentam maior ocorrência de violência sofrida e abuso sexual, perda de seus filhos para o conselho tutelar e mudanças em seus hábitos de vida, como o sono. Conclusões: É necessário refletir a respeito do desenvolvimento de políticas públicas sobre a atenção oferecida para as pessoas que considerem a perspectiva de gênero

‘No memory, no desire’: psychoanalysis in Brazil during repressive times

Until recently, the growth and significance of Brazilian psychoanalysis has been neglected in histories of psychoanalysis. Not only is this history long and rich in its professional and cultural dimensions, but there was an especially important ‘event’ – the so-called ‘Cabernite-Lobo affair’ – that took place during the period of the military dictatorship, which can be seen as dramatising some of the issues concerning the erasure of memory in psychoanalysis, especially in connection with political difficulties. In this paper, we provide an outline of the origins and dissemination of psychoanalysis in Brazil before looking again at the Cabernite-Lobo affair in order to examine in a situated way how psychoanalysis engages with political extremism, and particularly to explore the consequences of an unthinking generalisation of the idea of ‘neutrality’ from the consulting room to the institutional setting. We draw especially on Brazilian papers in Portuguese, which have not been accessible in the English-language psychoanalytic literature

Training curriculum in minimally invasive emergency digestive surgery : 2022 WSES position paper

Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.Peer reviewe

Postoperative pain management in non-traumatic emergency general surgery : WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.Peer reviewe

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies