Ley de Salud Mental n° 26657: consecuencias de su implementación en la concepción teórica, abordaje y dirección de la cura en el tratamiento de adicciones

La presente investigación tiene como objetivo ubicar las consecuencias de la implementación de la Ley 26657 de Salud Mental en el área de adicciones. Sus objetivos específicos son el relevamiento del impacto en los efectores de la Ley (profesionales de salud mental, judiciales y funcionarios) y el aporte de contenidos teórico-metodológicos a la formación en competencias de los estudiantesy graduados. Para relevar el primer objetivo, se realizaron entrevistas y encuestas a dichos profesionales en la Ciudad Autónoma de Buenos Aires y el Conurbano Sur dentro del ámbito público. Como resultado, puede mencionarse que la mayoría de los entrevistados concuerdan con la concepción teórica de que las adicciones son un padecimiento mental, considerándolo como un avance introducido por la ley. Coinciden, además, en que las nuevas intervenciones conviven con viejas prácticas estigmatizantes. Justifican este escenario como un proceso de adecuación que requierede cambios culturales y paradigmas profesionales. Asimismo, señalan como dirección del tratamiento la inclusión social de los grupos de mayor vulnerabilidad, y para ello la necesidad de la intersectorialidad unida a la interdisciplina. Se insiste en la insuficiente adecuación de los recursos existentes a las nuevas prácticas emanadas de la Ley 26657. Esto, sumado a la resistencia de ciertos actores a asumir responsabilidades y ceder espacios de poder, son las dos principales dificultades referenciadas. En tanto es incipiente el funcionamiento del Órgano de Revisión, la mayoría de los entrevistados desconoce sus acciones concretas. En relación al segundo objetivo específico, puede concluirse que los alumnos refieren algún conocimiento de la Ley de Salud Mental, ningún conocimiento del Plan IACOP y disparidad de conocimiento respecto a las normas y tratados internacionales. Con respecto a la autopercepción de la formación en DDHH, adicciones, Salud Pública y Trabajo Interdisciplinario sostienen que es básica y deberían ampliarla. Respecto al conocimiento de abordajes de adicciones, un número significativamente elevado responde negativamente. Consideran a los temas indagados en la encuesta como muy relevantes, y coinciden en la necesidad de incluirlos en la formación académica. Se promovió la participación de las alumnas integrantes del Equipo en todas las instancias del procesode investigación, aportando así a su formación.This research focuses its goals on locating the consequences of Law implementation 26657 in Mental Health within the area of addictions. Its specific goals are to relieve the impact on effectors of Law (mental health professionals, judicial professionals and officials) and provide theoretical and methodological contents to training skills of students and graduates.To relieve this first objective, professionals of Buenos Aires city and its south suburbs area were interviewed. Interviews and surveys were the methodological tools applied.The following conclusions were reached: Most respondents agree on the theoretical concept of addiction as a mental suffering, considering it as a progress introduced by the law. They also agree that the new interventions coexist with old stigmatizing practices. They justify this scenario as aprocess of adaptation that requires cultural changes and professional paradigms. They point out the social inclusion of the most vulnerable groups as the direction of the treatment and the need forinter-sectoriality together with inter-discipline. It insists on the insufficient adequacy of existing resources to new practices derived from Law 26657. This situation added to the resistance from certain actors to take responsibilities and give positions of power become the two main difficulties. Considering the incipient operation of the Review Body, most respondents do not know its concreteactions. As regards the second goal, it shall be concluded that students refer some knowledge on the Mental Health Law, no knowledge on the IACOP Plan [Integral Plan for the Approach of Problematic Drug Use] and disparity of knowledge about rules and international treaties. Regarding the self-perception of training in Human Rights, addictions, Public Health and Interdisciplinary Work, they argue that it is basic and should be extended. As regards knowledge of approaches toaddictions, a significantly high number responds negatively. They consider the issues investigated in the survey as very important and they agree on the need for including them in academic training. Student’s participation in the entire research process was promoted in order to contribute in their own training

Gunshot injuries in the maxillofacial region : a retrospective analysis and management

Aim: To analyze gunshot wounds to the face, assessing the characteristics, immediate treatment, late treatment, complications and after effects. Methods: A retrospective observational study was carried out involving 75 cases of victims of gunshot wounds to the face treated at the Oral and Maxillofacial Traumatology Unit of the Dr. Arthur Ribeiro de Saboya Hospital in the city of São Paulo (Brazil).Data analysis used the chi-square test with the level of significance set at 5% (p dd 0.05). Results: There was a predominance of the 21-to-30-year-old age group (38.7%), male gender (92%) and wounds occurring due to assaults (37.3%). There was a predominance of entry wounds on the left side of the face (58.5%). The most affected sites were the mandible (50.7%), maxilla (18.3%), zygomatic region (7.0%), eye socket (4.2%) and nose (1.4%). Comminuted fractures (88.2%) and simple fractures (10.3%) were recorded. No fracture occurred in 1.5% of the cases. The predominant treatment was rigid internal fixation (RIF) (57.2%), followed by exploratory surgery (23.2%) and conservative treatment (19.6%). Among the cases in which the RIF system was used, there was predominance in the mandible (64.0%). The chi-square test revealed a significant correlation between the 2.4-mm RIF system and the mandible in 48.0 % of cases. Conclusions: In conclusion, gunshot wounds tended to pierce the face, mainly affecting the mandible and caused comminuted fractures treated with rigid internal fixation. Immediate complications occurred in 25% of cases and after effects occurred in 11.7%

Gunshot injuries in the maxillofacial region: a retrospective analysis and management

yze gunshot wounds to the face, assessing the characteristics, immediate treatment, late treatment, complications and after effects. Methods: A retrospective observational study was carried out involving 75 cases of victims of gunshot wounds to the face treated at the Oral and Maxillofacial Traumatology Unit of the Dr. Arthur Ribeiro de Saboya Hospital in the city of São Paulo (Brazil).Data analysis used the chi-square test with the level of significance set at 5% (p dd 0.05). Results: There was a predominance of the 21-to-30-year-old age group (38.7%), male gender (92%) and wounds occurring due to assaults (37.3%). There was a predominance of entry wounds on the left side of the face (58.5%). The most affected sites were the mandible (50.7%), maxilla (18.3%), zygomatic region (7.0%), eye socket (4.2%) and nose (1.4%). Comminuted fractures (88.2%) and simple fractures (10.3%) were recorded. No fracture occurred in 1.5% of the cases. The predominant treatment was rigid internal fixation (RIF) (57.2%), followed by exploratory surgery (23.2%) and conservative treatment (19.6%). Among the cases in which the RIF system was used, there was predominance in the mandible (64.0%). The chi-square test revealed a significant correlation between the 2.4-mm RIF system and the mandible in 48.0 % of cases. Conclusions: In conclusion, gunshot wounds tended to pierce the face, mainly affecting the mandible and caused comminuted fractures treated with rigid internal fixation. Immediate complications occurred in 25% of cases and after effects occurred in 11.7%