Atendimento psicossocial grupal a adolescentes que cometeram ofensa sexual

This text presents a group psychosocial intervention proposal with adolescents that have committed sexual offenses and characterized by family intervention perspective (Multifamily Group). In addition to the demand for care for adolescents aged 12 to 15 years old that have committed a sexual offense, the inclusion of the age group from 16 to 18 years has been observed. These two age groups, 12-15 and 16-18, present different characteristics in relation to the violence suffered in their short life histories, as well as the severity of the violence committed. The proposal developed was made up of seven sessions of three hours each, with predefined themes that have targeted interventions for participants according to their age: children, adolescents and adults. Each session was organized into three moments: warm-up, discussion of the topic and conclusion. The intervention method included ludic activities and some psychodramatic resources adapted to adolescents of both age groups and their families. This text is descriptive and reports an intervention adapted to the context of adolescents in these age groups and their families, based on broader action-research. The possibilities of the proposal are discussed, based on the observations of professionals that have conducted the intervention, together with information present in the literature about sexual offenses committed by adolescents. The need for future studies that deepen about the topic of adolescents and young adults that committed sexual offense is emphasized, considering the specificities of these age groups. The limits of the proposal and the challenges in its applicability are also indicated.El objetivo de este texto es presentar una propuesta de atención psicosocial en grupo con adolescentes que han cometido delitos sexuales, con la perspectiva de intervención familiar (Grupo Multifamiliar). Además de la demanda de atención a adolescentes de 12 a 15 años que han cometido un delito sexual, se observa la inclusión del grupo etario de 16 a 18 años. Estos dos grupos de edad presentan características diferentes en relación a la violencia sufrida en sus cortas historias de vida, así como a la gravedad de la violencia cometida. La propuesta desarrollada estuvo compuesta por siete sesiones de tres horas cada una, con temáticas predefinidas que contaron con intervenciones dirigidas según su edad: niños, adolescentes y adultos. Cada sesión se organizó en: calentamiento, discusión del tema y conclusión. El método de intervención incluyó actividades lúdicas y recursos psicodramáticos adaptados a ambos grupos de edad y sus familias. Este texto es descriptivo y presenta la intervención adaptada al contexto de los adolescentes de estos grupos etarios y sus familias, a partir de una investigación-acción más amplia. Se discuten las posibilidades de la propuesta, a partir de las observaciones de los profesionales que han conducido la intervención, junto con informaciones presentes en la literatura sobre delitos sexuales cometidos por adolescentes. Se destaca la necesidad de estudios futuros que profundicen en el tema de los adolescentes y jóvenes que cometieron delitos sexuales, considerando las especificidades de estos grupos etarios. También se señalan los límites de la propuesta y los desafíos en su aplicabilidad.O objetivo deste texto é apresentar uma proposta de atendimento psicossocial grupal realizada com adolescentes que cometeram ofensa sexual e caracterizada por uma perspectiva de serem atendidos em família (Grupo Multifamiliar). Além da demanda por atendimentos a adolescentes de 12 a 15 anos que cometeram ofensa sexual, tem sido observada a inclusão da faixa etária de 16 a 18 anos. Estas duas faixas etárias, 12-15 e 16-18 anos, apresentam distintas características com relação às violências sofridas em suas curtas histórias de vida, bem como à gravidade das violências cometidas. A proposta desenvolvida foi composta por sete sessões de três horas cada, com temas pré-definidos que têm processamentos dirigidos aos participantes em função de suas idades: crianças, adolescentes e adultos. Cada sessão se organizou em três momentos: aquecimento, discussão do tema e conclusão. O método do atendimento incluiu atividades lúdicas e utilização de recursos psicodramáticos adaptados aos adolescentes das duas faixas etárias e aos familiares. O presente texto é descritivo e relata a proposta de atendimento realizada adaptada para o contexto de adolescentes nessas faixas etárias e seus familiares, a partir de uma pesquisa-ação mais ampla. Discutem-se as possibilidades da proposta, a partir das observações dos profissionais que realizaram atendimento grupal, em conjunto com as informações presentes na literatura sobre ofensa sexual cometida por adolescentes. Ressalta-se a necessidade de estudos futuros que aprofundem sobre o tema de adolescentes que cometeram ofensa sexual, considerando as especificidades dessas faixas etárias. Indicam-se ainda os limites da proposta e impasses em sua aplicabilidade

Intimacy and attachment in dating relationships: implications from case studies for violence prevention

Experiências de apego seguro na infância podem impactar comportamentos de busca de intimidade ao longo da vida, consistindo em um dos fatores de proteção para a qualidade das relações amorosas. Este estudo, baseado na teoria do apego, teve o propósito de examinar vivências de intimidade nas relações de namoro. Realizou-se um estudo de casos múltiplos com entrevistas semiestruturadas, conduzidas com três jovens, duas mulheres e um homem, com idades entre 16 e 23 anos. Os resultados apontam singularidades na vivência da intimidade, com níveis elevados de intimidade associados à troca de apoio social entre os parceiros e sensibilidade às necessidades do outro, e níveis ameaçados de intimidade associados à esquiva da busca de suporte junto ao parceiro e estratégias negativas de resolução de conflitos. Os dados corroboram a teoria do apego, segundo a qual disponibilidade e acessibilidade do parceiro são a via central para se promover proximidade emocional nas relações amorosas. Conclui-se que ações preventivas devem enfocar a receptividade e acessibilidade ao outro, habilidades para busca e oferta de ajuda, habilidades de regulação das emoções em situações de manejo de conflitos e o uso de recursos internos, do parceiro e do contexto para ressignificar legados emocionais parentais que sustentam a esquiva e a ansiedade em relações íntimas. Palavras-chave: apego, violência pelo parceiro íntimo, relacionamento interpessoal, intimidade, qualidade conjugal. Experiences of secure attachment in childhood can impact life intimacy seeking behaviors, consisting of one of the protective factors for the quality of love relationships. This study, based on attachment theory, aimed to examine intimacy experiences in dating relationships. A multiple cases study was conducted with semi-structured interviews with three young people, two women and one man, aged between 16 and 23 years old. The results point to singularities in the intimacy experience, with high levels of intimacy associated with the exchange of social support between the partners and sensitivity to the needs of the other, and levels of threatened intimacy associated with the avoidance of seeking support from the partner and negative resolution strategies of conflicts. Results corroborate the attachment theory, according to which availability and accessibility of the partner are the central way to promote emotional closeness in love relationships. We concluded that preventive actions should address the receptivity and accessibility to the partner, help seeking and help giving skills, emotional regulation skills in conflict management and the utilization of internal, partner’s and contextual resources to attribute new meaning to parental emotional legacy that sustains avoidance and anxiety in intimate relations. Keywords: Attachment, intimate partner violence, interpersonal relationship, intimacy, marital quality

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Adolescents that have committed sexual offense, their contexts and vulnerabilities

Dissertação (mestrado)—Universidade de Brasília, Instituto de Psicologia, Programa de Pós-graduação em Psicologia Clínica e Cultura, 2020.A ofensa sexual é uma questão complexa e de saúde pública. É necessário que mais estudos sejam desenvolvidos no contexto brasileiro considerando o autor da ofensa, a fim de avançar esse conhecimento e intervir adequadamente, possibilitando a interrupção do ciclo da violência. Nesta pesquisa, buscou-se aprofundar o conhecimento sobre os adolescentes, a partir da inspiração dos estudos de David Finkelhor sobre polivitimização sofrida na infância e adolescência. O objetivo foi identificar as vulnerabilidades presentes nos contextos pessoal, sexual, familiar e social/comunitário dos adolescentes que cometeram ofensa sexual. O estudo teve como fundamentação epistemológica o Pensamento Sistêmico considerando a perspectiva de inter-relação entre os fenômenos. Compreende-se que os adolescentes estão em um período de desenvolvimento, em que ocorrem várias mudanças, e estão inseridos em seu contexto sócio-histórico-cultural. É principalmente na fase da adolescência que a sexualidade está se desenvolvendo e sendo descoberta. Compreende-se que o cometimento do ato sexual ofensivo ocorre devido a um conjunto de diversos fatores. Esta pesquisa foi realizada em uma unidade de saúde pública que oferece atendimento especializado para adolescentes que cometeram ofensa sexual e suas famílias (CEPAV Jasmim). O método utilizado foi de caráter qualitativo a partir da pesquisa-ação com complementação das informações por meio da aplicação de outros instrumentos. Os adolescentes participaram de entrevistas psicossociais e de uma intervenção psicossocial grupal, o Grupo Multifamiliar (GM) – parte da ação desta pesquisa. A coleta de informações foi realizada antes, durante e após o GM, com os seguintes instrumentos: registros das histórias de vida, registros das sessões do GM, Genogramas, Mapas da Rede e desenhos da planta baixa da casa e do mapa da vizinhança. Participaram da pesquisa nove adolescentes e suas famílias. A apresentação dos resultados foi organizada de acordo com as vulnerabilidades constantes de cada instrumento. Nas histórias de vida, observaram-se vulnerabilidades relativas aos adolescentes, à escolaridade, à família e às vítimas. Nas sessões do GM, identificaram-se ausência de confiança nas relações familiares, necessidade de proteção e orientação, dúvidas e dificuldades em conversar sobre sexualidade e diversas violências. Nos Genogramas, houve presença de diversos conflitos e violências nas famílias. Nos desenhos da planta baixa da casa e do mapa da vizinhança, destacou-se uma organização interna e externa, em princípio, adequadas. Nos Mapas da Rede, houve distribuição equilibrada entre os quadrantes, com representação de poucas pessoas, presença de profissionais do sistema socioeducativo e unidades de saúde. A discussão foi apresentada conforme as vulnerabilidades identificadas em cada contexto. No contexto pessoal, foi discutido sobre polivitimização, sentimentos e educação formal; no contexto sexual: educação sexual, assim como violências e sexualidade; no contexto familiar: organização interna e qualidade da interação familiar; e no contexto social/comunitário: organização externa, condição socioeconômica e rede de apoio. Observou-se que os adolescentes da pesquisa vivem em contextos interconectados por vulnerabilidades, e apresentam maior vulnerabilidade nas relações familiares violentas; além de carência de proteção, diálogo e educação sexual, sendo importante que sejam orientados e supervisionados. O estudo possibilitou iniciar um caminho para o planejamento de ações visando à prevenção do cometimento da ofensa sexual, identificando aspectos de vulnerabilidade para intervir, com articulação entre saúde, assistência e justiça. Espera-se que as informações construídas sejam úteis para a prática profissional e embasamento de políticas públicas, com aprimoramento de intervenções com os adolescentes autores de ofensa sexual e suas famílias, pois é importante oferecer um serviço de qualidade, embasado cientificamente e que considere os contextos intra e extrafamiliar.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).Sexual offense is a complex public health issue. More studies must be developed considering the offender in the Brazilian context, in order to advance this field of knowledge and intervention, enabling the interruption of the cycle of violence. In order to deepen the knowledge about adolescents, this study is based on David Finkelhor's studies of polyvictimization suffered in childhood and adolescence. The objective of this research was to identify the vulnerabilities present in the personal, sexual, family and social/community contexts of the adolescents that have committed sexual offense. The study had an epistemological foundation on System Thinking considering the perspective of interrelationship between phenomena. It is understood that adolescents are in a period of development, in which several changes occur, and they are inserted in their own socio-historical- cultural context. It is mainly during adolescence that sexuality is developed and discovered. It is understood that the sexual offense occurs because of several factors. The research was carried out in a public health institution that offers specialized treatment for adolescents that have committed sexual offense and their families (CEPAV Jasmim). The method used was qualitative based on action research with complementation through other instruments. The adolescents participated in psychosocial interviews and in a psychosocial group intervention, the Multifamiliar Group (MG) – part of the action of this research. The collection of information was carried out before, during and after the MG, with the following instruments: records of participants’ life histories, records of the MG sessions, Family Genograms, Maps of Social Network and drawings of the house floor plan and the neighborhood map. Nine adolescents and their families participated in the research. The results were organized according to the type of vulnerabilities contained in each instrument. In participants’ life histories, vulnerabilities were observed in relation to adolescents, education, family and victims. In the sessions of the MG, observations indicated a lack of trust in family relationships, the need for protection and guidance, doubts and difficulties in talking about sexuality and various types of violence. In the participants’ Family Genograms, there was the presence of several conflicts and violence in the families. In the drawings of the house floor plan and the neighborhood map, adequate internal and external organizations were observed. In the Maps of Social Network, there was a balanced distribution between the quadrants, with representation of few people, the presence of professionals from the socio-educational system and health units. The discussion was presented according to the vulnerabilities identified in each context. In the personal context, polyvictimization, feelings and formal education were discussed; in the sexual context: sex education as well as violence and sexuality; in the family context: internal organization and quality of family interaction; and in the social/community context: external organization, socioeconomic status and support network. It was observed that the adolescent participants of this research live in contexts interconnected by vulnerabilities, amongst which violent family relationships was the most frequent type of vulnerability found. Other vulnerabilities observed included lack of protection, dialogue and sex education. Strategies to deal with these findings demand orientation and supervising of these adolescents. This study allows planning of actions aimed at preventing sexual offense, identifying aspects of vulnerability to step in, with articulation of health, social work and justice systems. The information constructed might be useful for professional practice and implementation of public policies, promoting the improvement of interventions with adolescent sexual offenders and their families, as it is important to offer a quality, scientifically based service that considers intra and extrafamilial contexts

Ofensa sexual cometida por adolescentes/jovens adultos - DOI https://doi.org/10.29327/226091.54.2-8

O objetivo deste artigo é discutir a ofensa sexual cometida por adolescentes/jovens adultos e as implicações sociais e jurídicas decorrentes. A adolescência é um período em que ocorrem mudanças significativas e a ofensa sexual é uma questão de saúde pública, complexa e multideterminada. Cometer ofensa sexual na faixa etária entre 16-21 anos traz a necessidade de compreensão contextualizada, pois envolve dimensões jurídicas diferenciadas. Trata-se de uma pesquisa documental com os prontuários de cinco adolescentes atendidos em uma instituição de saúde pública. Os dados foram analisados a partir de categorias que conectam as vitimizações a aspectos sociofamiliares e implicações jurídicas. Os resultados apresentaram a polivitimização na história de vida e um ponto limite de virem a lidar com conjunto de regras de criminalização ou de proteção, de enfrentarem contextos jurídicos com legislações diferentes, quando ainda pertencem ao mesmo contexto familiar e à mesma comunidade. A responsabilização não pode ser a única resposta

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status