A MEDICALIZAÇÃO NAS RELAÇÕES SABER-PODER: UM OLHAR ACERCA DA INFÂNCIA MEDICALIZADA

O presente trabalho foi realizado por meio de pesquisa de revisão bibliográfica que tem como foco o estudo da medicalização na sociedade construída por meio de estratégias normatizadoras. Visa compreender os processos de medicalização na sociedade, pautados principalmente nas relações de poder-saber, e os discursos que delas advêm. Pretende-se traçar um histórico da construção desse conceito, compreendendo-se suas delimitações e ações que refletem no grande consumo de medicamentos no intuito de acabar ou diminuir um sofrimento da forma mais rápida possível. Além disso, almeja-se discutir a presença desses processos no universo infantil, compreendendo-se os processos diagnósticos que tendem a biologizar as relações sociais e afetivas e a legitimação destes nas escolas, famílias e sociedade. Pôde ser observado, por meio destas análises, que os processos medicalizantes delimitam o indivíduo, normatizam-no, minando sua possibilidade de posicionar-se histórica e politicamente. Autores como Michel Foucault, Ivan Illich, Peter Conrad, Ian Hacking, seus comentadores e outros autores serviram de base para o presente artigo

A Multiplicidade do TDAH nas Diferentes Versões Produzidas pelas Ciências no Brasil

From an Actor-Network Theory standpoint, this research aimed at discussing the different ADHD realities enacted by Brazilian scientific literature and to describe the production of different versions about the phenomenon by the action of its heterogenic networks. We selected 80 Brazilian scientific papers from Lilacs, Pepsic, BVS, Scielo and IndexPsi databases using ADHD as a keyword according to DeCS (health science descriptors). The discussion indicates three different versions of ADHD that connect, detach, overlap and activate different realities by agency of humans and non-humans actors. We hope this research can contribute to creating an approach to ADHD that considers its assemblage and that foster a broad and hybrid comprehension of this phenomenon.A partir da Teoria Ator-Rede, esta revisão teve como objetivos discutir as diferentes realidades performadas pela literatura científica brasileira sobre o TDAH e descrever a produção de versões acerca do fenômeno por meio do funcionamento de suas redes heterogêneas. Selecionamos 80 artigos científicos brasileiros das bases de dados Lilacs, Pepsic, BVS, Scielo e IndexPsi utilizando o descritor TDAH. A discussão aponta para diferentes versões do TDAH, que se distanciam, se conectam, se sobrepõem e agenciam diferentes realidades por meio das relações entre agentes humanos e não humanos que participam da construção destas versões. Espera-se que a presente pesquisa possa contribuir com um olhar para o TDAH por meio de seus agenciamentos, com base na busca de uma compreensão mais ampla e híbrida deste fenômeno

PERFIL DE CUIDADORES DE LA TERCERA EDADE EN UNA INSTITUCIÓN DE LARGA PERMANENCIA EN IMPERATRIZ, MA

Diante do aumento da oferta de trabalho dos profissionais cuidadores de idosos e da escassez de literatura sobre seu perfil foi realizado um estudo observacional, do tipo transversal com cuidadores formais de uma instituição de longa permanência para idosos no munícipio de Imperatriz – MA. Os objetivos do trabalho foram descrever variáveis sociodemográficas, identificar as dificuldades enfrentadas durante o exercício das atividades laborais, além de avaliar o estado de saúde dos cuidadores. A amostra foi composta por 14 profissionais que auxiliavam os idosos na realização das atividades diárias e aceitaram participar do estudo. Os resultados obtidos sugerem que os cuidadores avaliados são em sua maioria mulheres solteiras, com menos de 50 anos de idade, com baixa renda salarial, que receberam algum tipo capacitação para o cuidado dos idosos. Pela análise dos resultados foi possível concluir que os cuidadores necessitam de suporte dos serviços de saúde para prevenir e/ou minimizar a sobrecarga de trabalho e possíveis enfermidades. O estudo também evidencia a importância de se conhecer as dificuldades institucionais vivenciadas pelos cuidadores, buscando enfoque para a reorganização dos serviços de assistência ao idoso institucionalizado.Faced with increased labor supply of caregivers for elderly and the scarce literature about their sociodemographic and clinical profile, observational research was carried out with formal caregivers in a long-term care facility in the city of Imperatriz – MA. The goals were to describe sociodemographic variables, identify difficulties during work activities, and evaluate the health status of caregivers. The sample was composed of 14 professionals who helped the elderly carry out daily activities. Data collection was carried out from April to May 2015 through questionnaires answered individually by caregivers, following a structured script previously tested. The questions were read to the respondents and the answers were filled out by the interviewers. A descriptive technique was used In the statistical analysis. The results evidenced that 42.8% of participants were between 31 and 40 years old, 64.2% were women, 42.8% were single, 50% had personal income of up to one minimum wage, 50% had no complete high school, and 71.42% received some kind of training to care for the elderly. In addition, 64.3% of respondents considered it necessary to receive medical care to check their health status. For the analysis of the results it was concluded that caregivers need support of health services to prevent and/or minimize the workload and possible illnesses. The study also highlights the importance of knowing the institutional difficulties experienced by caregivers, seeking to approach the reorganization of support services for institutionalized elderly.Ante el aumento de la oferta de trabajo de los cuidadores de de la tercera edad y la escasez de su perfil sociodemográfico y clínico, se llevó a cabo un estudio observacional con los cuidadores formales de una Institucione de Larga Permanencia para Mayores en el municipio de Imperatriz – MA. Los objetivos fueron describir las variables sociodemográficas, identificar las dificultades enfrentadas durante la realización de las actividades de trabajo y evaluar el estado de salud de los cuidadores. La muestra se compone de 14 profesionales que ayudaron a las personas mayores en la realización de las actividades diarias y aceptaron participar em el estudio. La recolección de datos se llevó a cabo entre abril y mayo de 2015 mediante cuestionarios respondidos de forma individual por el cuidador, a raíz de la escritura estructurada previamente probado. Las preguntas fueron leídas a los encuestados y las respuestas llenas, por extensión, en la forma. En el análisis estadístico, se utilizó la técnica descriptiva. Los resultados mostraron que 42,8% tenía entre 31 y 40 años, 64,2% de los cuidadores eran mujeres; 42,8% eran solteros; 50% tenía ingresos personales de hasta un salario mínimo; 50% no había completado la escuela secundaria y 71,42% recibido algún tipo de formación para el cuidado de los ancianos. Además, 64,3% de los encuestados consideró necesario recibir atención médica para comprobar su estado de salud. Para el análisis de los resultados se concluyó que los cuidadores necesitan apoyo de los servicios de salud para prevenir y/o reducir al mínimo la carga de trabajo y las posibles enfermedades. El estudio también muestra la importancia de conocer las dificultades institucionales que experimentan los cuidadores y centrarse en la reorganización de los servicios de atención para los ancianos institucionalizados

Prevenção e manejo de complicações pós-cirúrgicas em cirurgias oculares

A prevenção e o manejo de complicações pós-cirúrgicas em cirurgias oculares são vitais para otimizar os resultados do paciente e minimizar a morbidade. Este artigo apresenta uma revisão abrangente das principais complicações após cirurgias refrativas, de catarata, glaucoma e da retina, fornecendo estratégias para prevenir e gerenciar tais complicações. As complicações discutidas incluem ectasia corneana, infecção ocular, edema macular cistóide, opacificação da cápsula posterior, hipotonia ocular, falha do filtro, descolamento de coróide, hemorragia vítrea, entre outras. As estratégias para prevenir essas complicações são variadas, desde a seleção adequada do paciente e o aperfeiçoamento da técnica cirúrgica até o uso de medicamentos apropriados no pós-operatório. Ao mesmo tempo, as estratégias de manejo podem envolver intervenções médicas ou cirúrgicas adicionais para tratar complicações emergentes. A revisão destaca a importância de um cuidado personalizado, baseado em evidências, para cada paciente, a fim de minimizar as complicações e otimizar os resultados

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

A indústria farmacêutica e psicanálise diante da "epidemia de depressão": respostas possíveis

O crescimento de diagnósticos de depressão verificado na atualidade vem acompanhado da ampliação do mercado da indústria farmacêutica, do comércio de antidepressivos e do fenômeno da medicalização da vida. O objetivo do estudo teórico é analisar os fatores que subjazem ao que o sociólogo Philippe Pignarre denominou de "epidemia de depressão", fenômeno complexo que não deve ser reduzido a fatores unicamente biológicos ou sociais, mas carrega em seu bojo uma economia de fármacos em expansão. Serão levantados alguns dados sobre as estratégias da indústria farmacêutica para ganhar o terreno em expansão dos diagnósticos e elevar seus medicamentos ao patamar de produtos a serem consumidos, tornando-se um dos setores mais rentáveis do mundo. Em seguida, questiona-se o estatuto da psicanálise na sociedade medicalizada, a partir das críticas que esta tem recebido nas últimas décadas, sobretudo na França, revelando a incapacidade do sujeito contemporâneo de expressar em palavras o sofrimento que o acomete

Older children adoption: about legal issues and emotional link construction

Older children adoption is one matter among an entire context of profound changes in the concept of family. Older children adoption is the adoption of children over the age of two; such type of adoption is still highly disregarded by Brazilian adopters. By using theoretical documentary research methodology, we analysed the Brazilian law on older children adoption. Treating the impasses emerged from the construction of emotional links between parents and older children adoptees and the theoretical contributions psychology may adjoin to this establishing relationship

Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity.

The purpose of the study was to identify and compare validity parameters of different absolute intensity thresholds in METs, using relative intensity classification as criterion measure. Convenience sampling was used to recruit total of 112 adults. The participants carried out an incremental maximal cycle ergometer test and asked to perform nine free-living activities. The oxygen uptake was measured by a VO2000® gas analyser throughout the tests. The intensity thresholds were identified using Receiver Operator Characteristic (ROC) curve analysis, having relative intensity categories as criterion measure. A total of 103 participants attended the two visits. Among 54 men and 49 women, the mean (± SD) ages were 36.1 (± 11.1) and 33.9 (± 10.6) years, respectively. The intensity thresholds identified were 4.9 METs for moderate and 6.8 METs for vigorous physical activity. In conclusion, the physical activity thresholds, generated according to the entire sample, were higher and presented improved specificity when compared to thresholds currently recommended. Moreover, these parameters presented relatively high accuracy, even when applied to specific groups such as sex, age, nutritional status and physical fitness